Data Quality Analyst - Education

Overview

About Public Consulting Group

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 Education practice offers consulting services and technology solutions that help schools, school districts, and state education agencies/ministries of education to promote student success, improve programs and processes, and optimize financial resources. To learn more, visit http://www.publicconsultinggroup.com/education/.

Responsibilities

Role: Data Quality Analyst

Program: Medicaid Direct Service/Fee-for-Service (FFS)

PCG helps school districts and state agencies across the country support the delivery of health-related services by helping schools access more than $500M in Medicaid reimbursement each year.

The Data Quality Analysts help to ensure the quality of claims. They review claims generated for compliance and unclaimed services for optimization opportunities. Data Quality Analysts must be highly detail-oriented, analyzing the completeness of data before approving or rejecting claims within the system. Analysts will perform in-depth research to verify the quality of information throughout the adjudication lifecycle of the service. Data Quality Analysts should be comfortable utilizing various technology tools and systems to effectively identify and triage any issues.

Specific Responsibilities

• Validate the accuracy of claims submission and payment information through research with state agency or MMIS site
• Understand Federal and state Medicaid policy as it pertains to our clients and their claims
• Provide strategic solutions when errors arise; address, and respond to Triage request from assigned clients
• Review and verify the accuracy of import errors and claim exceptions for each claiming
• Adhere to requirements around HIPAA and FERPA in terms of data security
• Review and compare data information from multiple systems
• Verify and validate healthcare claims, service logs, and compliance data files included in the claiming process for PCG clients utilizing Microsoft Access, Business Intelligence reporting, and proprietary systems designed by PCG
• Manage all aspects of assigned clients’ state-specific Quality Control requirements and maintain the QC portion of the current state FFS Claiming Procedure Manual
• Review and analyze data transferred into UBS for accuracy and timeliness according to set claiming schedule
• Perform Quality Assurance review of eligibility data, along with claimed and unclaimed samples prior to claims submission
• Troubleshoot claiming questions and issues as they arise with a sense of appropriate urgency
• Review data trends when it comes to imports, claims, and remits to identify any risks or optimization opportunities

Qualifications

Required Work Experience and Education

• Previous work experience in Quality Control, Auditing, and/or Analysis
• 1+ year of relevant work experience
• Work experience in Healthcare Claims

Required Skills

• Ability to drive problems to their resolution
• Problem-solving skills and ability to interpret complex data sets
• Independent, logical, strategic thinker with high focus
• Competency in PCG technologies (UBS, EDPlan, Advanced Reporting) as well as Microsoft Office (Word, Outlook, Excel)
• Demonstrated excellence in quickly understanding and adopting new technologies
• Demonstrated time management and organizational skills
• Strong comfort and usage of project management tool - Asana
• Professional maturity and ability to put the best interests of the client and PCG above self-interest
• Effective written and verbal communication
• Strong attention to detail and disciplined work ethic

#REMOTE

#LI-REMOTE

#LI

#EDU

Compensation

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: $65,000 - $75,000. In addition, PCG provides a range of benefits for this role.

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.