Public Consulting Group Medical Coding Specialist in Boston, Massachusetts
About Public Consulting Group
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. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, clients in six Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com .
PCG is seeking a Medical Coder to provide support on the National Correct Coding Initiative (NCCI) program as an independent contractor representing PCG and reporting to J29 principles. The NCCI program is administered by the CMS, Center for Program Integrity (CPI) to minimize fraud, waste, and abuse in medical claims processing.
This individual will utilize their coding expertise by mitigating coding errors to prevent improper payments within federal healthcare programs of Medicare and Medicaid. This role requires excellent organizational skills and attention to detail. The ideal candidate will be comfortable not working in a coding production environment, and instead comfortable using coding knowledge to interpret subject matter expertise tasks on the program.
Demonstratable knowledge in interpreting healthcare procedures, services, drugs, and supplies into
medical code sets under NCCI program
Provide continuous review of the current NCCI PTP (Procedure to Procedure), MUE (Medically
Unlikely Edits) and AOC (Add-On Code) edit programs and to further develop, improve and expand
those programs to prevent improper payments
Evaluate claim information to ensure that NCCI accurately reflects CMS payment and coverage
policies and procedures
Reads bulletins, newsletters, and periodicals and attends working group meetings to stay abreast of
issues, trends, and changes in laws and regulations governing the NCCI program and associated
coding or policy requirements
Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply
policies, procedures, laws, and regulations Organizational Relationships
Administrative duties included compiling agendas for workgroup meetings, assist in creating
presentations, handouts, and finalizing meeting meets for group review
Reports directly to the ASO Senior Operations Director and J29 Principle
Education: Minimum education of a bachelor’s degree from an Accredited University or College Certified with an accredited medical coding certification, held in active standing
Experience: Minimum of 5+ years’ experience in interpreting/coding HCPCS/CPT codes and coding conventions
Certification: Current medical coding certification (i.e., RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H minimum)
Deep Subject Matter Expertise with a solid understanding in all aspects of the CMS NCCI programpolicies and application of these requirements in revenue cycle activities
Thorough understanding of RCM (Revenue Cycle Management) to include validation processes,payment methodologies, and other reimbursement requirements, specifically CMS (Medicare /Medicaid) guidelines and NCCI edits
Experience working with Medicare and Medicaid payment, coverage and coding policies –preferably stakeholder engagement with mentioned policies and subject matter groups
Strong analytical and healthcare research skills needed
Strong writing capabilities in order to document findings and suggested updates to NCCI regulations
Azure SQL database experience highly desired
Thorough knowledge and expertise in a remote-working environment with virtual collaboration withboth internal and external groups
Preferred experience working on Federal programs with prior experience working directly withgovernment stakeholders, with agencies such as the Centers for Medicare and Medicaid Services(CMS).
Proficient with Microsoft Office 365 (O365) applications, such as Outlook, SharePoint, Teams, Excel,OneDrive, and Word. Require intermediate Excel skills to include V-Lookup, pivot table creation,concatenation, etc.
CMS Regulatory Research – Transmittals, Manuals 30%
New Drug HCPCS Research – Package Inserts, Dosing Parameters 15%
Data Manipulation in Excel – prepare files for Medical Director 20%
Azure SQL Database Searches 10%
CPT/HCPCS Research – understanding codes and their use 15%
Present Research Findings to NCCI Team 10%
Active Listening Skills
Attention to Detail
Open Communication with Peers – Ability to work individually and with team-members
Ability to Take Initiative with Minimal Supervision
This is a high profile, high energy and demanding environment with extended periods of computer use for claims processing and research. Often requires meeting with client and/or agency team members to discuss results of audits
Remote Work Statement
This position is a remote, work from home position. PCG is a remote-friendly organization and is committed to creating a culture where remote work remains a vital part of the company’s success. To be successful in a remote work role at PCG, you must:
be available during your set working hours
have a safe, private, and distraction-free environment in which to complete your work, and
be able to give your full attention to the completion of your PCG job duties
Some travel to the office or elsewhere may be required for team meetings, client meetings, etc.
Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role: $75,000 and a potential discretionary bonus of up to 10%. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.
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 employmentregarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programsare 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 3 weeks ago (2/7/2024 3:20 PM)
Job ID 2024-10142
# of Openings 1
Category Information Technology
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.
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