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Revenue Cycle Managed Services - Clinical Denials Sr. Manager

AT PwC
PwC

Revenue Cycle Managed Services - Clinical Denials Sr. Manager

Raleigh, NC

At PwC, our people in finance focus on providing financial advice and strategic guidance to clients, helping them optimise their financial performance and make informed business decisions. These individuals handle financial analysis, budgeting, forecasting, and risk management. In financial operations at PwC, you will focus on managing financial processes and confirming compliance with regulations. You will handle tasks such as financial reporting, budgeting, and risk management.

Growing as a strategic advisor, you leverage your influence, expertise, and network to deliver quality results. You motivate and coach others, coming together to solve complex problems. As you increase in autonomy, you apply sound judgment, recognising when to take action and when to escalate. You are expected to solve through complexity, ask thoughtful questions, and clearly communicate how things fit together. Your ability to develop and sustain high performing, diverse, and inclusive teams, and your commitment to excellence, contributes to the success of our Firm.

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

  • Craft and convey clear, impactful and engaging messages that tell a holistic story.
  • Apply systems thinking to identify underlying problems and/or opportunities.
  • Validate outcomes with clients, share alternative perspectives, and act on client feedback.
  • Direct the team through complexity, demonstrating composure through ambiguous, challenging and uncertain situations.
  • Deepen and evolve your expertise with a focus on staying relevant.
  • Initiate open and honest coaching conversations at all levels.
  • Make difficult decisions and take action to resolve issues hindering team effectiveness.
  • Model and reinforce professional and technical standards (e.g. refer to specific PwC tax and audit guidance), the Firm's code of conduct, and independence requirements.

Minimum Degree Required
Bachelor's Degree

Required Field(s) of Study
Nursing

Additional Educational Requirements

An equivalent combination of education and/or work experience may also be considered.

Minimum Year(s) of Experience (BQ)
8 year(s) 8 years of experience in case management, utilization review, or denial management in a business setting.

Certification(s) Required (BQ)

æRN licensure

Preferred Qualifications

Degree Preferred
Master's Degree

Certification(s) Preferred

Case Management certification (CMGT-BC, ACM, CMAC)

Preferred Knowledge/Skills

Demonstrates intimate-level abilities and/or a proven record of success managing efforts with identifying and addressing client needs:
- Manages the internal clinical denial and appeals team to diligently investigate payer denied claims and deliver quality outcomes;
- Utilizes thorough knowledge of InterQual, Milliman Care Guidelines and EMR chart review;
- Prepares and reports on payer clinical denial activity, financial impact and opportunity to improve;
- Identifies coding and clinical documentation trends related to different cases and various insurance carriers; and,
- Applies extensive knowledge of the payer industry, revenue cycle management, revenue cycle process, and appeal process.
Demonstrates intimate-level abilities and/or a proven record of success managing efforts with identifying and addressing client needs:
- Applies working knowledge of medical records documentation, CPT, HCPCS, DRGs and billing compliance rules;æ
- Mentors and trains teams as needed on clinical denial writing skills;
- Solves complex problems and issues using analytical abilities;
- Communicates Medicare rules and regulations, commercial payer coverage guidelines, and thorough understanding of the claim dispute process for various payers;
- Exhibits proven oral/written communication skills, organizational skills and attention to detail;
- Provides proven customer service skills and demonstrates ability to work with a diverse group of people;
- Develops and updates clinical denial policies and procedures as applicable; and,
- Displays proficiency in Microsoft Office (i.e., Word, Excel, PowerPoint, Visio, etc.).

Learn more about how we work: https://pwc.to/how-we-work

PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy.

All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer.

The salary range for this position is: $103,500 - $233,000, plus individuals may be eligible for an annual discretionary bonus. For roles that are based in Maryland, this is the listed salary range for this position. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation and more. To view our benefits at a glance, please visit the following link: https://pwc.to/benefits-at-a-glance

Client-provided location(s): Raleigh, NC, USA
Job ID: PricewaterhouseCoopers-613990WD
Employment Type: Other

Perks and Benefits

  • Health and Wellness

    • FSA
    • HSA
    • Fitness Subsidies
    • HSA With Employer Contribution
    • Health Insurance
    • Dental Insurance
    • Vision Insurance
    • Life Insurance
    • Short-Term Disability
    • Long-Term Disability
  • Parental Benefits

    • Non-Birth Parent or Paternity Leave
    • Birth Parent or Maternity Leave
  • Work Flexibility

    • Flexible Work Hours
    • Remote Work Opportunities
  • Office Life and Perks

    • Company Outings
    • Commuter Benefits Program
    • Casual Dress
    • Happy Hours
    • Snacks
    • Some Meals Provided
  • Vacation and Time Off

    • Leave of Absence
    • Personal/Sick Days
    • Paid Holidays
    • Paid Vacation
    • Sabbatical
  • Financial and Retirement

    • Relocation Assistance
    • Performance Bonus
    • 401(K) With Company Matching
    • 401(K)
  • Professional Development

    • Learning and Development Stipend
    • Promote From Within
    • Mentor Program
    • Shadowing Opportunities
    • Access to Online Courses
    • Tuition Reimbursement
  • Diversity and Inclusion

    • Diversity, Equity, and Inclusion Program