Member Solutions Specialist - Remote

Overview

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.

In Short

• Manage a portfolio of zero-balance inpatient/outpatient accounts.
• Prepare and submit medical claims to insurance carriers.
• Investigate and resolve billing errors and discrepancies.
• Collaborate with internal teams to prioritize worklists.
• 2+ years of inpatient institutional billing experience required.
• Strong understanding of IL Medicaid and Medicare.
• Excellent analytical and communication skills needed.
• Familiarity with revenue cycle management software preferred.
• Experience with CPT/ICD-10 coding is a plus.
• Full-time and contract positions available.

Requirements

• 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.

Benefits

• Dental insurance
• Health insurance
• Paid time off