Medical Account Rep (Zero Balance Specialist)

At PCG Consulting Group, we are a leader in financial, recovery, insurance, and healthcare services based. Our innovative solutions and commitment to excellence have positioned us as a trusted partner in the industry. We leverage 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 member's contribution.

We are currently seeking an experienced and detail-oriented Medicaid Account Representative Zero Balance Specialist to join our team. The ideal candidate will have a strong background in inpatient institutional billing, Medicaid, 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, correcting underpayments, conducting audits, and identifying trends in high-dollar inpatient and outpatient accounts.

Key Responsibilities:

• Account Management: Manage a portfolio of zero-balance inpatient accounts, focusing on high-dollar and high-leakage opportunities.
• Billing & Collections: Assist in the billing and collection of medical services, ensuring accurate and timely processing.
• Issue Resolution: Investigate and resolve billing errors, underpayments, and discrepancies within Medicaid and MCO accounts. Communicate with insurance companies to resolve account-related issues promptly.
• Auditing: Conduct detailed audits of both inpatient and outpatient accounts to identify revenue leakage, ensure proper payments from responsible parties, and uncover hidden revenue opportunities.
• Trend Analysis: Identify trends in account discrepancies to maximize revenue collection opportunities.
• Collaboration: Work cross-functionally with internal teams to prioritize worklists and resolve high-value accounts quickly and accurately.
• Client Liaison: Act as a liaison for Salud clients by maintaining communication with client departments, third-party carriers, and the public, upholding Salud’s standards of service, mission, and vision.
• Timely Filing: Ensure timely filing of claims, particularly within Medicaid’s extended filing periods.

Job Types:

• Full-time
• Contract

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Job Types: Full-time, Contract

Benefits:

• Dental insurance
• Health insurance
• Paid time off

People with a criminal record are encouraged to apply

Work Location: Remote

• 2+ years of inpatient institutional billing experience, preferably with Medicaid and MCOs (Illinois Medicaid experience preferred).
• Proven track record of managing zero-balance accounts and successfully collecting significant sums.
• Strong understanding of Medicaid, MCOs, and state-specific regulations.
• Demonstrated ability to audit accounts and identify trends in revenue leakage.
• 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.
• Preferred: Knowledge of CPT/ICD-10 coding and experience with institutional claim processes.