Consultant, Payment Intelligence

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., 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" 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 space for personal development and fulfillment.The RoleHealth plans face continued challenges in reimbursing claims on-time and accurately. AArete's consulting service line, Payment Intelligence, goes beyond typical payment integrity to ensure erroneous and inefficient payments are identified, rectified, and recouped to prevent them in the future. Our Payment Intelligence team addresses issues with payment policies, provider contracts, provider data, covered benefits, member eligibility and prior authorizations.In this role, the individual will be responsible for client delivery of Payment Intelligence . The position will report to a Payment Intelligence Manager. The individual will be the subject matter expert on strategies to help our clients ensure proper claims payment through the use of (1) claims analytics, (2) process improvements, (3) integration of automation/technology, and (4) conf igurations setups. This role will support the internal development of Payment Intelligence initiatives including research and interpretation of healthcare policies and regulations, and experience in claims editing.Work You'll DoSupport the development, identification and analysis of payment accuracy opportunities through remediation with client counterpartsUtilize analytics to identify claims payment opportunities through your knowledge of standard payment methodologies including Prospective Payment Systems (IPPS/OPPS), fee for service, Groupers, RUG, etc.Support process improvements and automation initiatives for clientsConduct research on current events, changes in regulatory requirements and market trends impacting health plan reimbursementContribute to the preparation of client ready deliverables with clear and actionable insightExercise sound judgement and clear and direct communication in all aspects of your workOther duties as assignedRequirements2+ years of experience in a role within consulting, provider revenue cycle, a payment integrity vendor, and/or a payer organizationFoundational knowledge of claims processing across multiple lines of business, including Medicare, Medicaid, ACA/Marketplace, Commercial, and DualsExperience across various spend areas, including professional, ancillary, outpatient, and inpatient servicesAbility to identify and analyze mispaid claims 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 presentation expertiseExperience coaching and mentoring team membersAdvanced proficiency utilizing Microsoft ExcelStrong analytical, data interpretation, and problem-solving skillsAbility to identify client savings opportunities and develop actionable business casesBachelor's Degree or equivalentDirect client interaction with possible travel to client locationsMust be legally authorized to work in the United States without the need for employer sponsorshipPreferred RequirementsPolicy & Claims Editing Expertise Research and interpretation of healthcare policies and regulationsExperience in reimbursement policy writing and claims editingProficiency in 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 Expertise Interpretation of provider contract terms and pricing methodologies, including fee schedules, 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 MatchGenerous paid parental leave 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 is a part of a competitive, total compensation package together with our majority employer-paid benefits, and incentive pay for eligible roles. Please note that this range is a guideline and individual total compensation may vary due to numerous 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're a 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.And we've been recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine.We've earned a Great Place to Work Certification and been named a World's Best Management Consulting Firm by Forbes, Vault's Top 50 Firms to Work For , Crain's Chicago Business Fast 50, Inc 5000's Fastest Growing Firms , and Consulting Magazine's Fastest Growing Firms .Learn more about our award-winning cultureWe 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