Consultant, Payment Intelligence
11 days ago
New York
Consultant,Payment Intelligence AArete is one-of-a-kind when it comes to consulting firm culture. We'rea global, innovative management and technology consulting firm, with offices in the U.S., India, and the U.K. Our name comes from the Greek word for excellence: "Arete." And excellence is exactly what we strive for. Our success starts with enriching and empowering our people. From robust career development planning to competitive life and wellness benefits,AArete's"Culture of Care" takesa holistic approachto 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 space for personal development and fulfillment. The Role Health 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'llDo • Supportthe development,identificationandanalysisof payment accuracy opportunities through remediation with clientcounterparts, • Utilize 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 andautomationinitiativesforclients, • Conduct research oncurrent events, changes in regulatory requirements and market trendsimpactinghealth plan reimbursement, • Contribute to the preparation ofclient readydeliverableswith clear and actionable insight, • Exercisesoundjudgement and clear and direct communication in all aspects of your work, • Other duties as assigned Requirements • 2+ years of experience ina role withinconsulting, provider revenue cycle, a payment integrity vendor,and/or a payer organization, • Foundational knowledge ofclaims processing across multiple lines of business, including Medicare, Medicaid, ACA/Marketplace, Commercial, and Duals, • Experience across variousspendareas, including professional, ancillary, outpatient, and inpatient services, • Ability toidentifyand analyzemispaidclaims to ensure accuracy and compliance, • Knowledge of industry vendors and tools related to claims processing, provider data, and contract management, • Understanding of end-to-end claims processes, including claims management, provider lifecycle, and network optimization, • Strong professional communication skills, including written, verbal, interpersonal, and in-person presentationexpertise, • Experience coaching and mentoring team members, • AdvancedproficiencyutilizingMicrosoft Excel, • Strong analytical, data interpretation, and problem-solving skills, • Ability toidentifyclient savings opportunities and develop actionable business cases, • Bachelor's Degree or equivalent, • Direct client interactionwithpossibletravelto client locations, • Must be legally authorized to work in the United States without the need for employer sponsorship Preferred Requirements • Policy & Claims Editing Expertise, • Research and interpretation of healthcare policies and regulations, • Experience in reimbursement policy writing and claims editing, • Proficiencyin data mining to detect errors and inconsistencies, • Ability to crosswalk and compare edits and policies, • Knowledge of claims editing processes, including Prepay/Post-Pay, COB, Subrogation, Fraud Detection, and Medical Record Reviews, • Contract Configuration& Provider Data Expertise, • Interpretation of provider contract terms and pricing methodologies, including feeschedules,per diem, DRGs, cost-plus, and outlier payments, • Understanding of contract carve-outs, including bundled services,readmissions, and reductions, • Experience in contract pricing and claims reimbursement analysis, • Ability to price and reprice claims based on contractual agreements, • Understanding of provider TIN and NPI relationships, • Knowledge of the provider lifecycle, including Credentialing, Data Management, Contracting, and Configuration, • Familiarity with network processes, including Optimization, Adequacy, and Pricing, • Experience with SQL or other query languages, • Familiarity with claims adjudication systems (e.g.,Facets, QNXT,Amisys, etc.), • Based in Chicago, IL, and flexible to work from our Chicago office as needed Compensation &Benefits • Flexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidays, • Own Your Day flexible work policy, • Competitive majority employer-paid benefits: Medical, Dental, Vision, 401K Match, • Generouspaid parentalleave options, • Employer paid Life Insurance, STD, LTD, • Charitable contribution matching program, • New client commission opportunities and referral bonus program, • Bike share discount program The 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 work We'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. We are an Equal Employment Opportunity Employer All 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
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