Job Description

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/.

This position will serve as both PCG’s internal Program Manager for our Claims Operations team, as well as the primary point of contact for our Medicare Advantage clients. Duties and responsibilities include:

• Serving as Medicare Advantage program subject matter expert by maintaining knowledge of federal legislative and regulatory changes impacting the Medicare Advantage program
• Providing strategic considerations and recommendations internally and to clients
• Driving active communication with clients and project team members to ensure the alignment and achievement of all client goals
• Serving as the point of contact for internal and external questions on strategy, requirements, documentation, functionality, and deliverables
• Implementing contracts to ensure systems, policies, and procedures are in place and functional
• Actively participating in Operational and Strategic Workgroups, setting agenda topics, and coordinating discussions as needed
• Individually and in collaboration with other departments, developing and monitoring key performance indicators (KPIs) and ensuring Service Level Agreements (SLAs) are at a minimum consistently attained, and will continuously assess the progress of the Medicare Advantage line of business for optimal performance
• Collaborate with the Training team to create training material and other source documents as needed including assistance with policies and procedures
• Working with the Operations team to accomplish other duties on the project to meet necessary deadlines

• Subject matter knowledge of Medicare Advantage programs, operations and claims operations practices, and industry trends
• Knowledge and experience related to Medicare Advantage plan implementation
• Excellent verbal and written communication and interpersonal skills
• Demonstrated attention to detail
• Ability to work independently and with a team
• Able to work in a fast-paced environment, demonstrate excellent problem solving, critical thinking, time management, and organizational skills
• Experience with Microsoft Office applications, specifically Outlook, Word, PowerPoint, and Excel
• Experience with database software is also a plus

Education:     Bachelor's Degree or higher is preferred or equivalent work experience

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

                        5+ years’ successfully managing or leading projects of various sizes (required)

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

                        Previous experience with claims processing systems (required)

                        Familiarity with Cognizant TriZetto healthcare products (preferred)

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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.