Consultant, Payment Analytics

AArete

United States

United States

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À propos

Description Join AArete, a remarkable consulting firm known for its exceptional culture and commitment to excellence. We are a global management and technology consulting company with offices in the U.S., India, and the U.K. Our name, derived from the Greek word for excellence, embodies our mission and values. At AArete, we prioritize the growth and well-being of our team members thanks to our holistic approach to the employee experience, termed 'Culture of Care.' We invest in robust career development, competitive life and wellness benefits, and promote a supportive environment that allows you to achieve your full potential. The Role As part of our Payment Intelligence® service line, you will play a crucial role in assisting health plans in overcoming challenges related to the timely and accurate reimbursement of claims. Our Payment Intelligence® team works diligently to identify and resolve payment errors and inefficiencies while developing strategies that ensure future claims payment accuracy. In this position, you’ll report to a Payment Intelligence® Manager and serve as a subject matter expert, offering strategies that leverage (1) claims analytics, (2) process enhancements, (3) technology automation integration, and (4) configuration setups. You will also contribute to the internal development of Payment Intelligence initiatives. Work You'll Do Collaborate with clients to develop, identify, and analyze opportunities for improving payment accuracy. Utilize your expertise in claims processing methodologies to spot payment opportunities, including Prospective Payment Systems, fee-for-service, and others. Champion process improvements and automation initiatives for client projects. Conduct research on emerging trends, regulatory changes, and market dynamics that impact health plan reimbursement. Prepare client-ready deliverables with actionable insights while ensuring clarity in communication. Exercise sound judgment and maintain direct communication across all aspects of your responsibilities. Take on additional tasks as assigned. Requirements At least 2 years of experience within consulting, provider revenue cycle management, payment integrity, or a payer organization. Foundational understanding of claims processing across various lines of business, including Medicare, Medicaid, and Commercial. Experience with various spend areas, covering professional, ancillary, outpatient, and inpatient services. Ability to identify and analyze mispaid claims for accuracy and compliance. Familiarity with industry tools related to claims processing and provider data management. Strong understanding of end-to-end claims processes, including management and network optimization. Exceptional communication skills, with experience in coaching and mentoring team members. Advanced proficiency in Microsoft Excel and basic to intermediate SQL for data analysis. Excellent analytical, data interpretation, and problem-solving abilities. A bachelor's degree or equivalent experience is required. Willingness to engage directly with clients, with potential travel to client locations. Legal authorization to work in the United States without sponsorship is necessary. Preferred Requirements Policy & Claims Editing Expertise
Research and interpretation of healthcare policies and regulations. Experience in writing reimbursement policies and claims editing. Proficiency in data mining for error detection. Ability to compare and contrast policies and edits. Knowledge of claims editing processes such as Prepay/Post-Pay, COB, and Fraud Detection.
Contract Configuration & Provider Data Expertise
Understanding of provider contract terms and pricing methodologies. Experience in analyzing claims reimbursement based on contracts. Ability to assess provider TIN and NPI relationships. Familiarity with the provider lifecycle, including Credentialing and Configuration.
Knowledge of claims adjudication systems, such as Facets or QNXT. Willingness to work from our Chicago office as needed. Compensation & Benefits Flexible PTO, monthly half-day refuels, volunteer time off, and 10 paid holidays. Own Your Day flexible work policy. Highly competitive and primarily employer-paid benefits, including Medical, Dental, Vision, and 401K Match. Generous parental leave options. Employer-paid Life Insurance and short/long-term disability coverage. Charitable contribution matching program. New client commission and referral bonus opportunities. Discount program for bike share services. The estimated base salary range for this position is $84,000 - $102,000, with additional opportunities for annual discretionary bonuses. This salary range serves as a guideline and total compensation may vary based on experience, certifications, and other business considerations. AArete is accepting applications until the role is filled. The job posting will be removed when the position is no longer available. We prioritize humanity in our work. As a consulting firm, we specialize in strategic profitability improvement, digital transformation, and change management. Our cross-sector solutions are enhanced by a digital-first mindset and data-driven approach, ensuring meaningful change and actionable insights for our clients. What truly sets us apart is our people, guided by principles of Excellence, Passion, Loyalty, Stewardship, Family, Community, Sustainability, and Inclusion. We’ve been recognized as a top firm to work for by reputable organizations, including Forbes and Consulting Magazine. Explore more about our award-winning culture. We are an Equal Employment Opportunity Employer and welcome applications from all qualified individuals, regardless of race, color, religion, gender, sexual orientation, national origin, disability, or veteran status.

United States

Compétences linguistiques

English

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