Portsmouth, New Hampshire

Overview

Public Consulting Group, Inc. (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide. PCG’s Health practice offers in-depth programmatic knowledge and regulatory expertise to help state and municipal health agencies respond to regulatory change, improve access to health care, maximize program revenue, improve business processes, and achieve regulatory compliance. Using industry best practices, PCG’s Health team helps organizations deliver quality services with constrained resources to promote improved client outcomes. To learn more, visit http://www.publicconsultinggroup.com/health/.

Responsibilities

  • Efficiently navigate the Cognizant/Trizetto QicLink claims system
  • Process paper and electronically submitted claims
  • Conduct further research into coding and pricing as needed
  • Accurately and timely respond to all correspondence from clients and/or their members
  • Resolve pended claims and process adjustments
  • Complete assigned claims tasks timely and accurately
  • Maintain understanding of departmental service standards, guidelines, policies, and procedures
  • Look for ways to improve efficiencies and minimize processing and workflow issues. Share information with team and management
  • Ensure Service Level Agreements (SLAs) and Key Performance Indicators (KPIs) are consistently attained

 

Qualifications

  • Demonstrated ability to use the QicLink claims system (a Cognizant suite of claims administration tools)
  • Proper etiquette including customer service techniques, superior verbal and communications skills
  • Excellent claim processing accuracy and attention to detail
  • Ability to prioritize work and meet deadlines
  • Ability to work in a fast-paced environment, demonstrate excellent problem solving, critical thinking, and organizational skills
  • Ability to recognize and maintain the confidentiality of all materials in the work setting
  • Understanding of modern office methods and practices; efficient with computers
  • Ability to work independently

Education:    High School Diploma or GED required; Bachelor's Degree preferred

 

Experience:  5+ years in the health insurance/revenue cycle industry (required)

                       5+ years’ in-depth knowledge of Medicare, Medicaid and Medicare Advantage experience (preferred)

                       Previous experience with claims processing system (required)

                       Familiarity with Cognizant TriZetto healthcare products, specifically QicLink (required)

 

 

 

 

 

 

EEO Statement

Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability.  VEVRAA Federal Contractor.

Portsmouth, New Hampshire

Founded in 1986 and headquartered in Boston, Massachusetts, Public Consulting Group (PCG) has nearly 2,000 professionals in over 60 offices around the U.S., in Canada, and in Europe who are dedicated to delivering leading consulting approaches and technologies to public sector clients.

Who We Serve

Public Consulting Group, Inc. (PCG) is a management consulting firm that primarily serves public sector education, health, human services, and other state, county, and municipal government clients. Established in 1986 with headquarters in Boston, the firm has extensive experience in all 50 states, clients in six Canadian provinces, and a growing practice in the European Union.

 

Because PCG has dedicated itself almost exclusively to the public sector for nearly 30 years, the firm has developed a deep understanding of the legal and regulatory requirements and fiscal constraints that often dictate a public agency's ability to meet the needs of the populations it serves. We have helped numerous public sector organizations to maximize resources, make better management decisions using performance measurement techniques, improve business processes, improve federal and state compliance, and improve client outcomes. Many of PCG's nearly 2,000 employees have extensive experience and subject matter knowledge in a range of government-related topics, from child welfare, Temporary Assistance for Needy Families (TANF), Welfare to Work (WtW), and Medicaid and Medicare policy to special education, literacy and learning, and school-based health finance. PCG's current work includes more than 1,000 active contracts in more than 40 states.

 

PCG has five designated practice areas which each have a proven track record of achieving desired results for clients. The firm often combines resources from two or more practice areas to offer a multidisciplinary approach to solve a client's challenge or pursue an opportunity.

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