Provider Operations Analyst

Location: Boston, MA

Department: Operations

Practice Area: S&F

Job Code: 01-08-100-59-08

Description:

Responsiblities:

• Maintain the integrity of the provider database and resolves the provider issues on a daily basis.
• Act as the liaison with all clients to resolve provider issues, claims logging issues, policies and procedures.
• Perform quality assurance testing of provider and fee schedule loads and perform quality assurance testing of claims against reimbursement schedules. 
• Assist in creating business rules for loading of provider records and updates and for functionality provider maintenance forms.
• Request, maintain and resolve W-9 forms in all provider files and assist in resolving claims issues.
• Work with IT regarding provider feeds and create and maintain contracts in the claims system contract database.

Qualifications:

• A Bachelor’s degree or equivalent experience and at least 2 years related experience, preferably in a provider operations capacity.
• A solid understanding of the health insurance industry, provider and facility reimbursement systems, data management, business systems and process management.
• Knowledge of Medicare and Medicaid reimbursement methodologies is a plus.  
• Must demonstrate strong verbal and written communication skills, attention to detail and analytical abilities.
• The desire and ability to work in a fast-paced team environment.

How to Apply:

If you are applying for a particular position please download and complete an application for employment, a cover letter stating the position you are inquiring about and the voluntary Affirmative action form and send it to pcghr@pcgus.com.

Application For Employment

Click Here for an Application All applicants who come in for an interview are also invited to complete a self-identification form. This is a voluntary questionnaire and completed forms may be faxed to us confidentially at 617-338-7994 or sent by mail to Public Consulting Group Inc., 148 State Street, 10th floor, Boston, MA 02109 attn: HR.

Voluntary Affirmative Action Form

As a federal contractor, we are required by law (41 CFR, Part 60-3) to report the gender, race, and ethnicity of all employees. We ask your assistance in helping us to comply by completing our Voluntary Affirmative Action Form and attaching it along with your resume.

Providing the information is entirely voluntary on your part. It will be used for statistical and reporting purposes only and will not become part of your employment file upon hire.

Click Here for your Voluntary Affirmative Action Form

If you do not have a pdf reader, please download and install Acrobat Reader in order to view and print the above forms.

Remember

All positions currently eligible for PCG Employee Referral Bonus, See Human Resources for details.PCG is proud to be an Equal Opportunity/Affirmative Action Employer.

• No phone calls accepted.
• Only applicants with specific requisitions will be considered.

If you are contacted by our office for an interview, you will be asked to print out and bring this completed application form to your first appointment. All applicants who are selected for an interview are required to complete an application.

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