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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, You’ll 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)
Responsibilities:
As Quality Control Analyst specific responsibilities include but are not limited to:
- 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.
Required Knowledge and Skills:
- 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
Job Summary –
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
Preferred Field(s) Of Study:
Minimum Year(s) of Experience (BQ) *: US
1 year of experience
Required Knowledge/Skills (BQ):
- Preferred Qualification: Bachelor’s degree in finance or Any Graduate
- 2-4 years of progressive experience in healthcare revenue cycle management, with a focus on accounts receivable and claims resolution.
- Strong knowledge of medical billing processes, insurance reimbursement methodologies, and revenue cycle operations.
- Experience with healthcare billing software (e.g., Epic, Cerner, Meditech) and proficiency in Microsoft Office applications.
- Excellent leadership, communication, and interpersonal skills with the ability to mentor and motivate team members.
- Analytical mindset with the ability to interpret financial data, identify trends, and make data-driven decisions.
- Proven track record of achieving AR performance targets and improving revenue cycle efficiency.
- Experience Level: 2 to 4 years
- Shift timings: Flexible to work in night shifts (US Time zone)
Preferred Knowledge/Skills *:
Accounts Receivable Management:
- Oversee the accounts receivable process, including insurance and patient follow-up, to minimize outstanding balances.
- Monitor and analyze aging reports to prioritize and address delinquent accounts promptly.
- Implement strategies to improve collections and reduce accounts receivable days.
Insurance And Payer Relations:
- Lead efforts in resolving complex insurance claim issues, including claim denials and underpayments.
- Establish and maintain relationships with insurance company representatives to facilitate prompt payment and claims processing.
- Stay updated on insurance policies, reimbursement regulations, and industry trends affecting revenue cycle operations.
Patient Communication And Customer Service:
- Assist with escalated patient inquiries and complaints related to billing and insurance matters.
- Educate patients on insurance benefits, coverage details, and financial responsibilities.
- Collaborate with patient advocacy groups and financial counselors to ensure compassionate and effective patient interactions.
Process Improvement And Training:
- Identify opportunities for process improvements within the revenue cycle management workflow.
- Develop training materials and conduct sessions to enhance the skills and knowledge of AR team members.
- Implement best practices to streamline AR operations and maximize efficiency.
Reporting And Analysis:
- Generate and present regular reports on accounts receivable performance metrics, trends, and outcomes.
- Utilize data analytics to identify root causes of revenue cycle issues and implement corrective actions.
PMS Experience:
- Epic HB & PB experience is Mandatory
Compliance And Regulatory Adherence:
- Ensure compliance with HIPAA regulations, billing guidelines, and healthcare industry standards.
- Collaborate with compliance officers to implement and maintain effective internal controls.