Managed Services-BOS - Appeals & Grievances- Associate

About this role

Line of Service
Advisory

Industry/Sector
Not Applicable

Specialism
Managed Services

Management Level
Associate

Job Description & Summary
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 Virtual Business Office team will provide you with the opportunity to act as an extension of our healthcare clients' business office. We specialize in revenue cycle functions and remediating aged 3rd party accounts receivable 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 a Senior 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:

Required Knowledge and Skills 

• Strong verbal and written communication skills, including letter writing experience.  
  

• Language skills: 
  

• Excellent English skills with the ability to read, comprehend, write and communicate verbally with stakeholders & customers. 
  
• Proficiency in Spanish as a first or second language would be preferred. 
  

• Ability to work with firm deadlines, multi-task, set priorities and pay attention to details 
  
• Ability to successfully interact with members, medical professionals, health plan and government representatives. 
  
• Knowledge of operational managed care terminology. ICD-10 and CPT codes a plus 
  
• Proficiency with Microsoft Word, Excel, and PowerPoint.  
  
• Excellent organizational, interpersonal and time management skills.  
  
• Must be detail-oriented and an enthusiastic team player.  
  
• Knowledge of Pega computer system a plus.  
  
• Preferred experience with appeals and grievances 
  
  

• Operational managed care experience (call center, appeals or claims environment). 
  
• Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria. 
  
• Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. 
  

Desired Languages (If blank, desired languages not specified)

Travel Requirements
Not Specified

Available for Work Visa Sponsorship?
No

Government Clearance Required?
No

Job Posting End Date