Consultant, Payment Intelligence

Summary

DescriptionConsultant,Payment IntelligenceAArete is one-of-a-kind when it comes to consulting firm culture.We're a global, innovative management and technology consulting firm with offices in the U.S. and India. Our name comes from the Greek word for excellence: "Arete." And excellence is exactly what we strive for.We're celebrating our fourth year as one of Forbes' World's Best Management Consulting Firms - and our success starts with our people. From robust career development planning to competitive life and wellness benefits, AArete's "Culture of Care" takes a holistic approach to the employee experience.AAretians (our team members) are leaders at every level. You are encouraged to unlock your full potential by directly contributing to our mission and prioritizing personal development and fulfillment.The RoleHealth plans face continued challenges in reimbursing claimson-timeand accurately.AArete'sconsulting service line,Payment Intelligence,goes beyond typical payment integrity to ensureerroneousand inefficient payments areidentified, rectified, andrecouped toprevent them in the future. Our Payment Intelligenceteamaddresses issues with payment policies, provider contracts, provider data, covered benefits, member eligibility and priorauthorizations.In this role, the individual willbe responsible forclient delivery ofPayment Intelligence.The position willreporttoa PaymentIntelligenceManager.The individual will be the subject matter expert on strategies to help our clients ensure proper claims paymentthrough the use of(1) claims analytics, (2) process improvements, (3) integration of automation/technology, and (4) configurations setups.This role will support the internal development of Payment Intelligence initiativesincluding research and interpretation of healthcare policiesandregulations,and experience inclaims editing.WorkYou'llDoSupportthe development,identificationandanalysisof payment accuracy opportunities through remediation with clientcounterpartsUtilize analytics toidentifyclaimspayment opportunities through your knowledge of standard payment methodologies including Prospective Payment Systems (IPPS/OPPS), fee for service, Groupers, RUG, etc.Support process improvements andautomationinitiativesforclientsConduct research oncurrent events, changes in regulatory requirements and market trendsimpactinghealth plan reimbursementContribute to the preparation ofclient readydeliverableswith clear and actionable insightExercisesoundjudgement and clear and direct communication in all aspects of your workOther duties as assignedRequirements2+ years of experience ina role withinconsulting, provider revenue cycle, a payment integrity vendor,and/or a payer organizationFoundational knowledge ofclaims processing across multiple lines of business, including Medicare, Medicaid, ACA/Marketplace, Commercial, and DualsExperience across variousspendareas, including professional, ancillary, outpatient, and inpatient servicesAbility toidentifyand analyzemispaidclaims to ensure accuracy and complianceKnowledge of industry vendors and tools related to claims processing, provider data, and contract managementUnderstanding of end-to-end claims processes, including claims management, provider lifecycle, and network optimizationStrong professional communication skills, including written, verbal, interpersonal, and in-person presentationexpertiseExperience coaching and mentoring team membersAdvancedproficiencyutilizingMicrosoft ExcelStrong analytical, data interpretation, and problem-solving skillsAbility toidentifyclient savings opportunities and develop actionable business casesBachelor's Degree or equivalentDirect client interactionwithpossibletravelto client locationsMust be legally authorized to work in the United States without the need for employer sponsorshipPreferred RequirementsPolicy & Claims Editing ExpertiseResearch and interpretation of healthcare policies and regulationsExperience in reimbursement policy writing and claims editingProficiencyin data mining to detect errors and inconsistenciesAbility to crosswalk and compare edits and policiesKnowledge of claims editing processes, including Prepay/Post-Pay, COB, Subrogation, Fraud Detection, and Medical Record ReviewsContract Configuration& Provider Data ExpertiseInterpretation of provider contract terms and pricing methodologies, including feeschedules,per diem, DRGs, cost-plus, and outlier paymentsUnderstanding of contract carve-outs, including bundled services,readmissions, and reductionsExperience in contract pricing and claims reimbursement analysisAbility to price and reprice claims based on contractual agreementsUnderstanding of provider TIN and NPI relationshipsKnowledge of the provider lifecycle, including Credentialing, Data Management, Contracting, and ConfigurationFamiliarity with network processes, including Optimization, Adequacy, and PricingExperience with SQL or other query languagesFamiliarity with claims adjudication systems (e.g.,Facets, QNXT,Amisys, etc.)Based in Chicago, IL, and flexible to work from our Chicago office as neededCompensation &BenefitsFlexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidaysOwn Your Day flexible work policyCompetitive majority employer-paid benefits: Medical, Dental, Vision, 401K MatchGenerouspaid parentalleave optionsEmployer paid Life Insurance, STD, LTDCharitable contribution matching programNew client commission opportunities and referral bonus programBike share discount programThe estimated base salary range for this position is$84,000-$102,000. In addition to this base salary, individuals may be eligible for an annual discretionary bonus. This range isa partof a competitive, total compensation package together with our majority employer-paid benefits, and incentive pay for eligible roles. Please note that this range is aguidelineand individual total compensation may vary due tonumerous factors including but not limited to experience level, certifications, and other relevant business considerations.AArete will accept applications until the position is filled. The job posting will be removed once the role is no longer available.We put humans at the center of our workWe'rea global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and strategy & change for clients. Our cross-industry solutions are powered by a digital-first mindset, market intelligence, and data-driven approach to deliver purposeful change, actionable insights, and guaranteed results.But what sets us apart is our people. We are guided by our deeply embedded guiding principles: Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion.Andwe'vebeen recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine.We'veearned aGreat Place to Work Certification and been named a World's Best Management Consulting Firm by Forbes, Vault'sTop 50 Firms to Work For, Crain's Chicago Business Fast 50, Inc 5000'sFastest Growing Firms, and Consulting Magazine'sFastest Growing Firms.Learn more about our award-winning cultureAArete, LLC ("AArete") may utilize Artificial Intelligence/Automated Decision-Making Technology/Automated Employment Decision Technology tools and resources ("AI" or "tools" or "resources") to assist humans in generating job descriptions and postings, recruitment, analyzation of information, screening candidates, evaluation of candidate information, and assisting humans in the selection of potential candidates by all levels of AArete employees for all positions.AArete may use Microsoft Co-Pilot, OpenAI ChatGPT, Anthropic Claude, Google Gemini, LinkedIn Recruiter AI and Hiring Assistant, Jobvite Talent Fit and AArete HireSense. AArete may use all the information you provide. Submission of information to AArete shall serve as consent to AArete's use of AI tools and resources. AArete complies with all applicable law and does not use AI to discriminate against any individual and does not use location or geographic data like zip codes to act in a discriminatory or illegal manner. Your personal data may be used in relation to prospective employment with AArete and will only be retained for so long as legally necessary.AArete shall comply with its posted privacy policies and candidates may contact Recruiting or Privacy Departments, as identified below, to request accommodations or to exercise any of your applicable rights, pursuant to applicable law:Recruiting: [emailprotected]Privacy: [emailprotected]We are an Equal Employment Opportunity EmployerAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.#LI-DNI

Job Description

DescriptionConsultant,Payment IntelligenceAArete is one-of-a-kind when it comes to consulting firm culture.We're a global, innovative management and technology consulting firm with offices in the U.S. and India. Our name comes from the Greek word for excellence: "Arete." And excellence is exactly what we strive for.We're celebrating our fourth year as one of Forbes' World's Best Management Consulting Firms - and our success starts with our people. From robust career development planning to competitive life and wellness benefits, AArete's "Culture of Care" takes a holistic approach to the employee experience.AAretians (our team members) are leaders at every level. You are encouraged to unlock your full potential by directly contributing to our mission and prioritizing personal development and fulfillment.The RoleHealth plans face continued challenges in reimbursing claimson-timeand accurately.AArete'sconsulting service line,Payment Intelligence,goes beyond typical payment integrity to ensureerroneousand inefficient payments areidentified, rectified, andrecouped toprevent them in the future. Our Payment Intelligenceteamaddresses issues with payment policies, provider contracts, provider data, covered benefits, member eligibility and priorauthorizations.In this role, the individual willbe responsible forclient delivery ofPayment Intelligence.The position willreporttoa PaymentIntelligenceManager.The individual will be the subject matter expert on strategies to help our clients ensure proper claims paymentthrough the use of(1) claims analytics, (2) process improvements, (3) integration of automation/technology, and (4) configurations setups.This role will support the internal development of Payment Intelligence initiativesincluding research and interpretation of healthcare policiesandregulations,and experience inclaims editing.WorkYou'llDoSupportthe development,identificationandanalysisof payment accuracy opportunities through remediation with clientcounterpartsUtilize analytics toidentifyclaimspayment opportunities through your knowledge of standard payment methodologies including Prospective Payment Systems (IPPS/OPPS), fee for service, Groupers, RUG, etc.Support process improvements andautomationinitiativesforclientsConduct research oncurrent events, changes in regulatory requirements and market trendsimpactinghealth plan reimbursementContribute to the preparation ofclient readydeliverableswith clear and actionable insightExercisesoundjudgement and clear and direct communication in all aspects of your workOther duties as assignedRequirements2+ years of experience ina role withinconsulting, provider revenue cycle, a payment integrity vendor,and/or a payer organizationFoundational knowledge ofclaims processing across multiple lines of business, including Medicare, Medicaid, ACA/Marketplace, Commercial, and DualsExperience across variousspendareas, including professional, ancillary, outpatient, and inpatient servicesAbility toidentifyand analyzemispaidclaims to ensure accuracy and complianceKnowledge of industry vendors and tools related to claims processing, provider data, and contract managementUnderstanding of end-to-end claims processes, including claims management, provider lifecycle, and network optimizationStrong professional communication skills, including written, verbal, interpersonal, and in-person presentationexpertiseExperience coaching and mentoring team membersAdvancedproficiencyutilizingMicrosoft ExcelStrong analytical, data interpretation, and problem-solving skillsAbility toidentifyclient savings opportunities and develop actionable business casesBachelor's Degree or equivalentDirect client interactionwithpossibletravelto client locationsMust be legally authorized to work in the United States without the need for employer sponsorshipPreferred RequirementsPolicy & Claims Editing ExpertiseResearch and interpretation of healthcare policies and regulationsExperience in reimbursement policy writing and claims editingProficiencyin data mining to detect errors and inconsistenciesAbility to crosswalk and compare edits and policiesKnowledge of claims editing processes, including Prepay/Post-Pay, COB, Subrogation, Fraud Detection, and Medical Record ReviewsContract Configuration& Provider Data ExpertiseInterpretation of provider contract terms and pricing methodologies, including feeschedules,per diem, DRGs, cost-plus, and outlier paymentsUnderstanding of contract carve-outs, including bundled services,readmissions, and reductionsExperience in contract pricing and claims reimbursement analysisAbility to price and reprice claims based on contractual agreementsUnderstanding of provider TIN and NPI relationshipsKnowledge of the provider lifecycle, including Credentialing, Data Management, Contracting, and ConfigurationFamiliarity with network processes, including Optimization, Adequacy, and PricingExperience with SQL or other query languagesFamiliarity with claims adjudication systems (e.g.,Facets, QNXT,Amisys, etc.)Based in Chicago, IL, and flexible to work from our Chicago office as neededCompensation &BenefitsFlexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidaysOwn Your Day flexible work policyCompetitive majority employer-paid benefits: Medical, Dental, Vision, 401K MatchGenerouspaid parentalleave optionsEmployer paid Life Insurance, STD, LTDCharitable contribution matching programNew client commission opportunities and referral bonus programBike share discount programThe estimated base salary range for this position is$84,000-$102,000. In addition to this base salary, individuals may be eligible for an annual discretionary bonus. This range isa partof a competitive, total compensation package together with our majority employer-paid benefits, and incentive pay for eligible roles. Please note that this range is aguidelineand individual total compensation may vary due tonumerous factors including but not limited to experience level, certifications, and other relevant business considerations.AArete will accept applications until the position is filled. The job posting will be removed once the role is no longer available.We put humans at the center of our workWe'rea global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and strategy & change for clients. Our cross-industry solutions are powered by a digital-first mindset, market intelligence, and data-driven approach to deliver purposeful change, actionable insights, and guaranteed results.But what sets us apart is our people. We are guided by our deeply embedded guiding principles: Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion.Andwe'vebeen recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine.We'veearned aGreat Place to Work Certification and been named a World's Best Management Consulting Firm by Forbes, Vault'sTop 50 Firms to Work For, Crain's Chicago Business Fast 50, Inc 5000'sFastest Growing Firms, and Consulting Magazine'sFastest Growing Firms.Learn more about our award-winning cultureAArete, LLC ("AArete") may utilize Artificial Intelligence/Automated Decision-Making Technology/Automated Employment Decision Technology tools and resources ("AI" or "tools" or "resources") to assist humans in generating job descriptions and postings, recruitment, analyzation of information, screening candidates, evaluation of candidate information, and assisting humans in the selection of potential candidates by all levels of AArete employees for all positions.AArete may use Microsoft Co-Pilot, OpenAI ChatGPT, Anthropic Claude, Google Gemini, LinkedIn Recruiter AI and Hiring Assistant, Jobvite Talent Fit and AArete HireSense. AArete may use all the information you provide. Submission of information to AArete shall serve as consent to AArete's use of AI tools and resources. AArete complies with all applicable law and does not use AI to discriminate against any individual and does not use location or geographic data like zip codes to act in a discriminatory or illegal manner. Your personal data may be used in relation to prospective employment with AArete and will only be retained for so long as legally necessary.AArete shall comply with its posted privacy policies and candidates may contact Recruiting or Privacy Departments, as identified below, to request accommodations or to exercise any of your applicable rights, pursuant to applicable law:Recruiting: [emailprotected]Privacy: [emailprotected]We are an Equal Employment Opportunity EmployerAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.#LI-DNI