Corp Managed Svcs RCMS - Associate - Billers - Operate

A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology. Our Revenue Cycle Managed Services team will provide you with the opportunity to act as an extension of our healthcare clients revenue cycle functions. We specialize in front, middle and back office revenue cycle functions for hospitals, medical groups, and other providers. We leverage our custom and automated workflow and quality assurance products to enable our clients to achieve better results, which ultimately allow them to provide better patient care.

To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future.

As An Associate, Youll Work As Part Of a Team Of Problem Solvers, Helping To Solve Complex Business Issues From Strategy To Execution. PwC Professional Skills And Responsibilities For This Management Level Include But Are Not Limited To:

Minimum Degree Required (BQ) *:

Bachelor’s Degree

Degree Preferred:

Bachelor’s Degree

Required Field(s) Of Study (BQ):

Computer Science, Data Analytics, Accounting

Preferred Field(s) Of Study:

Minimum Year(s) of Experience (BQ) *: US

2 years of experience

Certification(s) Preferred:

Required Knowledge/Skills (BQ):

Preferred Knowledge/Skills *:

The quality control analyst conducts quality control audits of patient accounts referred to the Revenue Cycle Managed Services (RCMS) and assures company and client standards are maintained and the integrity of client services are preserved. The Quality Control Analyst will perform a variety of functions including, but not limited to: reviewing and monitoring accounts, identifying problems, analyzing trends and suggesting recommendations for improvements. This role consults with and takes direction from the Continuous Improvement Specialist to resolve quality and efficiency issues that may occur on any given project.

• Years of Experience: 2-4 years is required in the following areas:Medical collections (Medical Collections Specialist II preferred), billing and/or claims experience
• Customer service experience
• ll payer knowledge required (government and non-government)
  
  

• Performs quality control audits; reviews and monitors accounts.
• Identifies problems, analyzes cause and effect, and suggests recommendations for improvement;
• Provides daily constructive feedback based on account notation;
• Identifies areas of weakness and communicates recommendations on changes and improvement to Continuous Improvement Specialists;
• Document findings of analysis. May prepare reports and suggests recommendations of implementation of new systems, procedures or organizational changes;
• Relies on specific instructions and pre-established guidelines to perform the functions of the job;
• Possesses ability to be confidential; Supports company compliance by demonstrating adherence to all relevant compliance policies and procedures; demonstrates knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of sensitive information;
• Consults and collaborates with Continuous Improvement Specialist to identify and assess training needs based on work audited;
• Participate in quality control meetings;
• Possesses considerable leadership skills, fostering an atmosphere of trust; seeks diverse views to encourage improvement and innovation; coaches and develops staff through timely and meaningful written feedback;
• Possesses a cooperative and positive attitude toward management and co-workers by responding politely and professionally and being a valued team player; and,
• Exemplifies extensive knowledge of the hospital revenue cycle with specialization in healthcare billing, follow-up, and the account resolution process to include, but not limited to: claims submission, acceptance, and adjudication, transaction reviews, adjustment posting, identification of patient responsibility, etc.
  
  

• Good analytical and math skills.
• Able to document problems and assist in their resolution.
• Demonstrated ability exceeding all established department/client quality and productivity standards;
• Proven ability to lead by example and foster mentoring relationships.
• Strong written and oral communication skills.
• Computer and internet literate in an MS Office environment; and,
• Ability to establish and maintain effective working relationships.
• US Healthcare Commercial and Managed Care Insurance Claim Management/Billing/Claim Edit Resolution
• US Healthcare Medicare and Medicaid Insurance Claim Management/Billing/Claim Edit Resolution
• US Healthcare Denials Management (technical and clinical)
• US Healthcare Underpayment/Payment Variance Management
• Experience Level: 2 to 4 years.
• Shift timings: Flexible to work in night shifts (US Time zone)
• Preferred Qualification: Bachelor’s degree in finance or Any Graduate
  
  

• Accurately enter charges into the practice management system.
• Review encounter forms, operative notes, and documentation for completeness.
• Apply correct CPT, HCPCS, and ICD-10 codes based on clinical documentation.
• Ensure billing compliance with specific guidelines and payer requirements.
• Submit clean claims to insurance carriers promptly to reduce denials.
• Coordinate with internal supervisors and coding staff for missing or unclear documentation.
  
  

• 2 and above years of medical billing/charge entry experience.
• Knowledge of CPT, HCPCS, ICD-10 coding, and payer billing rules.
• Familiarity with Medicare and commercial insurance billing.
• Strong attention to detail and accuracy.
• Flexible working in Shifts
  
  

• Post payments, adjustments, and denials from EOBs, ERA, and patient payments into the system.
• Reconcile daily deposits against bank statements.
• Identify and resolve credit balances in compliance with payer regulations.
• Process patient refunds and insurance overpayments timely.
• Collaborate with billing and AR teams to resolve discrepancies.
• Maintain accurate records for auditing and compliance.
  
  

• 2 and above years of payment posting experience in healthcare.
• Knowledge of EOB/ERA interpretation billing workflows.
• Experience handling credit balances and refunds.
• Proficiency with billing software and Excel.
• Flexible working in Shifts
  
  

• Review denied ophthalmology claims and determine the root cause (coding, documentation, eligibility, etc.).
• Correct and resubmit claims with accurate CPT/ICD-10 coding.
• Work with supervisors and coding staff to resolve documentation deficiencies.
• Prepare and submit appeals with supporting medical documentation.
• Track denial trends and recommend process improvements.
• Stay updated on payer policies and ophthalmology coding guidelines.
  
  

• 3 and above years of medical coding experience (ophthalmology preferred).
• Certified Professional Coder (CPC) or equivalent strongly preferred.
• In-depth knowledge of ophthalmology-specific coding, modifiers, and LCD/NCD guidelines.
• Strong analytical and problem-solving skills.
• Flexible working in Shifts
  
  

• Verify patient insurance eligibility and benefits prior to scheduled visits or procedures.
• Confirm coverage for exams, diagnostic tests (OCT, visual fields, etc.), and surgical procedures.
• Document copays, deductibles, coinsurance, and authorization requirements.
• Communicate insurance details to patients and front office staff.
• Work with insurance carriers to resolve eligibility issues.
• Maintain up-to-date records for compliance and billing accuracy.
  
  

• 2 and above years of experience in medical eligibility verification.
• Familiarity with payer requirements.
• Strong communication and customer service skills.
• Ability to manage multiple verification requests in a timely manner.
• Flexible working in Shifts