Corp Managed Svcs RCMS – Specialist – Hospital Billing, AR Calling, Denials Follow-up – Operate Full Time

At PwC, our people in operations consulting specialise in providing consulting services on optimising operational efficiency and effectiveness. These individuals analyse client needs, develop operational strategies, and offer guidance and support to help clients streamline processes, improve productivity, and drive business performance.

In operations and solutions at PwC, you will focus on providing consulting services to optimise overall operational performance and develop innovative solutions. You will work closely with clients to analyse operational processes, identify areas for improvement, and develop strategies to enhance productivity, quality, and efficiency. Working in this area, you will provide guidance on implementing technology solutions, process automation, and operational excellence frameworks.

You are a reliable, contributing member of a team. In our fast-paced environment, you are expected to adapt, take ownership and consistently deliver quality work that drives value for our clients and success as a team.

Skills

Examples of the skills, knowledge, and experiences you need to lead and deliver value at this level include but are not limited to:

• Apply a learning mindset and take ownership for your own development.
• Appreciate diverse perspectives, needs, and feelings of others.
• Adopt habits to sustain high performance and develop your potential.
• Actively listen, ask questions to check understanding, and clearly express ideas.
• Seek, reflect, act on, and give feedback.
• Gather information from a range of sources to analyse facts and discern patterns.
• Commit to understanding how the business works and building commercial awareness.
• Learn and apply professional and technical standards (e.g. refer to specific PwC tax and audit guidance), uphold the Firm’s code of conduct and independence requirements.
• JD Template
• RCMS -Corp Managed Svcs Patient Accounting
• Specialist
• Operate

A career in our Managed Services team will give you an opportunity to collaborate with many 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 allows them to provide better patient care.

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
• 1 year of experience

Certification(s) Preferred

Required Knowledge/Skills (BQ):

Preferred Knowledge/Skills *:

Insurance Follow-Up

Contact insurance companies via phone, email, or online portals to follow up on outstanding claims. Identify and resolve issues causing payment delays, such as claim denials or underpayments. Verify claim status, appeal denied claims, and resubmit claims when necessary.

Documentation And Reporting

• Maintain accurate and detailed documentation of all communications and actions taken. Update account information and billing systems with payment details and follow-up notes. Generate reports on accounts receivable status, aging trends, and collection efforts.
• Compliance and Regulations Adhere to HIPAA regulations and guidelines to ensure patient confidentiality and data security. Stay informed about insurance policies, billing guidelines, and industry changes affecting reimbursement.

Team Collaboration

Collaborate with internal departments, including billing, coding, and collections teams, to resolve payment issues. Participate in meetings and discussions to improve revenue cycle processes and workflow.

Requirements

PMS Experience:

• Proven experience (1-2 years) in healthcare revenue cycle management, specifically in accounts receivable follow-up and collections.
• Strong understanding of medical billing processes, insurance claims, and reimbursement methodologies.
• Excellent communication skills with the ability to effectively interact with insurance companies, patients, and internal stakeholders.
• Proficiency in using billing software, electronic health records (EHR), and Microsoft Office applications.
• Attention to detail and ability to prioritize tasks to meet deadlines.
• Knowledge of medical coding (ICD-10, CPT) is a plus.

Experience Level

1 to 2 years.

Shift Timings

Flexible to work in night shifts (US Time zone)