This job has closed.

Public Consulting Group · 3 weeks ago

Contract Support and RCM Analyst - Independent Contractor

United States

Full-time, Contract

Remote

Senior Level

$65/hr - $70/hr

5+ years exp

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. The Contract Support and RCM Analyst will support contractual administrative tasks and the entire claim process, including data entry, report analysis, claims processing, and medical record audits.

ConsultingManagement ConsultingService Industry

No H1B

Responsibilities

Quickly and effectively researches medical record audits using the internal applications and support documentation to determine compliance with agency specific requirements. Completes the audit results sheet and summaries as necessary or required by the contract. (20%)

Quickly and effectively researches denied claims to determine root cause of denial and solutions for correction by either the agency or internal fixes to the claiming application or validation routines. (20%)

Reviews claim files (837s) and remittance advice (835s) for accuracy and completeness. Calls or emails client, agency or other necessary individuals to secure and/or update incorrect or missing information. (10%)

Reviews all reference files needed by each agency for appropriate claim validation for accuracy and completeness. Calls or emails client, agency or other necessary individuals to secure and/or update incorrect or missing information. (30%)

Maintains and reviews all internal and external log sheets for accuracy and ensures all data is current and posted timely. (20%)

Qualification

ClaimingCoding certificationMedicaid requirements experienceCPTHCPCSICD-10-CM knowledgeMS-Office proficiencySmartsheet creationCommunication skillsTime managementProject management

Required

Understands federal, state, and local claiming requirements and guidance, especially Medicare and Medicaid

Must understand coding guidance, including CPT (Current Procedural Terminology), HCPCS (Healthcare Common Procedural Coding System), and ICD-10-CM (Internal Classification of Diseases, 10th Edition, Clinical Modification) as it affects the client and/or agency

Extensive experience in the full claim process particularly regarding Medicaid requirements

Experience with MS-Office (proficiency in Word, Excel, PowerPoint)

Proficiency in Word to include document structure and formatting

Proficiency in Excel to include Data Validation, Pivot Tables, Formulas, V-lookups, etc

Experience with Smartsheet creation and use

Creation and management of multiple types of smartsheets with understanding of organizational creation

Creation of dashboards, alerts, automations, conditional formatting, cell to sheet links, etc

Understanding Formulas and Functions for data analysis

Excellent oral and written communication required

Report Deliverables, Presentation preparation and potential delivery to internal and external clients

Must be able to manage clients, both internal and external directly and fairly

Must be able to manage time independently to ensure that deliverables and tasks meet contractual obligations of delivery dates

Preferred

Claiming or coding certification desired, preferably with a nationally recognized certify organization, either AAPC (American Academy of Professional Coders) and/or AHIMA (American Health Information Management Association)

Preferred candidate will have 5+ years of experience with significant claims processing and medical record auditing