Industry/Sector

Not Applicable

Specialism

Managed Services

Management Level

Senior Manager

Job Description & Summary

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.

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.

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.

Job Descriptions – Wolfe Project

Charge Entry / Biller

Responsibilities:

• 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.

Qualifications:

• 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

Cash Poster / Credit Balance Specialist

Responsibilities:

• 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.

Qualifications:

• 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

Denial Coder (Ophthalmology Specialty)

Responsibilities:

• 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.

Qualifications:

• 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

Eligibility Verification Specialist

Responsibilities:

• 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.

Qualifications:

• 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

Travel Requirements

Not Specified

Job Posting End Date