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Public Consulting Group Healthcare Billing Specialist in Boston, Massachusetts


Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, technology, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG employs approximately 2,000 professionals worldwide—all committed to delivering solutions that change lives for the better. The firm has extensive experience in all 50 states, Canada, and a growing practice in Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit .


  • Utilize software and Excel to analyze claim responses, and resolve claim issues

  • Monitor and analyze rejections and denials for trends and propose resolutions to management team

  • Monitor, review and work outstanding AR, analyze data for trends and advise supervisor/manager

  • Report progress to management team on weekly basis

  • Update and manage Policy and Procedure documentation

  • Any other duties assigned and relevant to the RCM of the project

  • Create reports from system using Excel and SQL

  • Monitor Electronic data interchange files (EDI files) including 837,999, 277, 270,271 and 835 files for potential posting issues into the system

  • Denials

  • Rejections

  • Eligibility

  • Payments

  • Develop new report templates to assist with monitoring of Revenue Cycle, as needed

  • Perform user acceptance testing on enhancement of system and new features


Education: College degree

Experience: 2-3 years of relevant work experience

Required Skills:

  • Ability to read/interpret EDI files (837, 999, 277, 270,271) and provide analytical support to team

  • Perform denials analysis to reduce controllable rejections. Perform deep-dive analysis to find solutions that can benefit our clients.

  • Develop new report templates to assist with monitoring of Revenue Cycle, as needed

  • Ability to provide a detailed assessment of revenue cycle processes with a focus on process improvement and best practices.

  • Applies knowledge of revenue cycle, including use of billable CPTs, diagnosis codes, modifiers, place of service codes, and systems to perform an in-depth analysis of root cause issues.

  • Identifies key topics and best practices for optimization and establishes mechanisms to share expertise and knowledge with team

  • Proficiency in health insurance billing, collections, and eligibility as it pertains to commercial, managed care, government payers.

  • Strong knowledge of electronic billing systems for front end and back end functions and the willingness to learn new systems, applications, and programs.

  • Demonstrated advanced skills in A/R management, problem assessment, and resolution, and collaborative problem-solving with complex claims issues.

  • Excellent analytical skills: attention to detail, critical thinking ability, decision making, and researching skills in order to analyze a question or problem and reach a solution.

  • Strong verbal and written communication skills.

  • Ability to work independently and follow-through and handle multiple tasks simultaneously.

  • Must be a motivated individual with a positive and exceptional work ethic.

  • Proficiency with Notepad++, Microsoft SQL, Microsoft Office, including Excel(Intermediate Level)


EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.


Job Locations US

Posted Date 2 weeks ago (11/21/2022 10:01 PM)

Job ID 2022-8852

# of Openings 1

Category Process and Analytics

Type Regular Full-Time

Practice Area Health Services

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.