Member Solutions Specialist

At PCG Consulting Group, we are a leader in the healthcare revenue cycle service industry based out of Maywood, IL. Our innovative solutions and commitment to excellence have positioned us to be a trusted partner in the industry. We are leveraging cutting-edge technology and a data-driven approach to deliver outstanding results for our clients. Joining our team means being part of a dynamic environment that encourages professional growth and values each team member's contribution.

We've partnered with our friends at Salud and are currently seeking an experienced and detail-oriented Member Solutions Specialist to join our team. The ideal candidate will have a strong background in inpatient institutional billing, IL Medicaid, Medicare, and Managed Care Organizations (MCOs), and a proven ability to identify and resolve revenue leakage from zero-balance accounts. You will be responsible for maximizing collections by resolving billing errors, identify and dispute underpayments, conducting audits, and identifying trends in high-dollar inpatient and outpatient accounts.

Key Responsibilities:

Account Management: Manage a portfolio of zero-balance inpatient/outpatient accounts, focusing on high charge to low reimbursement opportunities for additional revenue.

Billing & Collections: Prepares and submits medical claims to third-party insurance carriers either electronically or by hard copy. Additionally, team member will follow up with third-party insurance carriers and patients until claims are paid correctly.

Issue Resolution: Investigate and identity trends to resolve billing errors, underpayments, and discrepancies within multiple payor portals. Communicate with insurance companies to resolve account-related issues promptly.

Collaboration: Work cross-functionally with internal teams to prioritize worklists and resolve high-value accounts quickly and accurately.

Qualifications:

• 2+ years of inpatient institutional billing experience, preferably with IL Medicaid and Medicare Advantage plans
• Strong understanding of IL Medicaid, Medicare, MCOs, and state-specific regulations.
• Ability to audit accounts and identify trends in insurance underpayments.
• Excellent organizational, analytical, and communication skills, with meticulous attention to detail.
• Ability to work both independently and as part of a team. Proactive learner with the ability to quickly grasp new computer programs and websites.
• Strong problem-solving abilities to address complex billing and payment issues.
• Familiarity with revenue cycle management software and account auditing tools.
• Experience reading and interpreting EOBs, UB04s, Remittance Images
• Experience disputing/appealing/escalating claim issues/denials with insurance companies
• Preferred: Knowledge of CPT/ICD-10 coding and experience with institutional claim processes, Assurance, Siemens OAS Gold, Powerchart, Medi.

Job Types: Full-time, Contract

Benefits:

• Dental insurance
• Health insurance
• Paid time off

People with a criminal record are encouraged to apply

Application Question(s):

• Do you have experience with Zero Balance Accounts
• Do you have experience with Auditing Claims
• Do you have experience with UBO4's

Work Location: Remote