AArete
Description
Senior Consultant, Payment Intelligence AArete is a unique consulting firm known for its culture of excellence. We are a global, innovative management and technology consulting firm with offices in the U.S., India, and the U.K. Our name, derived from the Greek word for excellence, " Arete ," reflects our commitment to striving for excellence. Our success begins with empowering our people. From career development to comprehensive wellness benefits, AArete's "Culture of Care" adopts a holistic approach to employee experience. Our team members, called AAretians, are leaders at every level, encouraged to reach their full potential and contribute directly to our mission while fostering personal growth. The Role
Health plans face ongoing challenges in timely and accurate claim reimbursements. AArete's Payment Intelligence goes beyond typical payment integrity by identifying, rectifying, and recouping erroneous payments to prevent future issues. Our solution addresses payment policy issues, provider contracts, provider data, covered benefits, member eligibility, and prior authorizations. As a Senior Consultant, you will lead Payment Intelligence client delivery, reporting to a Payment Intelligence Manager. You will be the subject matter expert on strategies to ensure proper claims payment through analytics, process improvements, automation, and configuration setups. You will also support internal Payment Intelligence initiatives. Work You'll Do
Lead the development and root cause analysis of payment accuracy issues with clients Use analytics to identify claims payment opportunities, applying knowledge of payment systems like IPPS/OPPS, fee-for-service, Groupers, RUG, etc. Support automation advancements for clients Stay updated on regulatory changes and market trends affecting health plan reimbursement Prepare client-ready deliverables Exercise sound judgment and communicate clearly and effectively Perform other duties as assigned Requirements
4+ years of experience in consulting, provider revenue cycle, payment integrity, or payer organizations Expertise in claims processing across Medicare, Medicaid, ACA/Marketplace, Commercial, and Duals Experience with various spend areas, including professional, ancillary, outpatient, and inpatient services Ability to analyze mispaid claims for accuracy and compliance Knowledge of industry vendors and tools related to claims processing and provider data Understanding of end-to-end claims processes Strong communication skills and experience mentoring team members Proficiency in Microsoft Excel and basic/intermediate SQL Strong analytical and problem-solving skills Ability to identify savings opportunities and develop business cases Bachelor's degree or equivalent Experience with client interaction and willingness to travel Legal authorization to work in the U.S. without sponsorship Preferred Requirements
Policy & Claims Editing Expertise, including policy interpretation, claims editing, and error detection Contract Configuration & Provider Data Expertise, including contract terms, pricing methodologies, and provider lifecycle knowledge Familiarity with claims adjudication systems such as Facets, QNXT, Amisys Based in Chicago, IL, with flexibility to work from the office as needed Compensation & Benefits
Flexible PTO, volunteer time, paid holidays Own Your Day flexible work policy Competitive benefits: Medical, Dental, Vision, 401K Match Employee Stock Ownership Plan Paid parental leave, Life Insurance, STD, LTD Charitable matching, bonus programs, discounts The estimated base salary range is $105,000 - $125,000, with potential bonuses and a comprehensive benefits package. Actual compensation varies based on experience and qualifications. AArete is committed to diversity and inclusion, recognized as a top workplace and a leader in management consulting. We are an Equal Opportunity Employer.
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Senior Consultant, Payment Intelligence AArete is a unique consulting firm known for its culture of excellence. We are a global, innovative management and technology consulting firm with offices in the U.S., India, and the U.K. Our name, derived from the Greek word for excellence, " Arete ," reflects our commitment to striving for excellence. Our success begins with empowering our people. From career development to comprehensive wellness benefits, AArete's "Culture of Care" adopts a holistic approach to employee experience. Our team members, called AAretians, are leaders at every level, encouraged to reach their full potential and contribute directly to our mission while fostering personal growth. The Role
Health plans face ongoing challenges in timely and accurate claim reimbursements. AArete's Payment Intelligence goes beyond typical payment integrity by identifying, rectifying, and recouping erroneous payments to prevent future issues. Our solution addresses payment policy issues, provider contracts, provider data, covered benefits, member eligibility, and prior authorizations. As a Senior Consultant, you will lead Payment Intelligence client delivery, reporting to a Payment Intelligence Manager. You will be the subject matter expert on strategies to ensure proper claims payment through analytics, process improvements, automation, and configuration setups. You will also support internal Payment Intelligence initiatives. Work You'll Do
Lead the development and root cause analysis of payment accuracy issues with clients Use analytics to identify claims payment opportunities, applying knowledge of payment systems like IPPS/OPPS, fee-for-service, Groupers, RUG, etc. Support automation advancements for clients Stay updated on regulatory changes and market trends affecting health plan reimbursement Prepare client-ready deliverables Exercise sound judgment and communicate clearly and effectively Perform other duties as assigned Requirements
4+ years of experience in consulting, provider revenue cycle, payment integrity, or payer organizations Expertise in claims processing across Medicare, Medicaid, ACA/Marketplace, Commercial, and Duals Experience with various spend areas, including professional, ancillary, outpatient, and inpatient services Ability to analyze mispaid claims for accuracy and compliance Knowledge of industry vendors and tools related to claims processing and provider data Understanding of end-to-end claims processes Strong communication skills and experience mentoring team members Proficiency in Microsoft Excel and basic/intermediate SQL Strong analytical and problem-solving skills Ability to identify savings opportunities and develop business cases Bachelor's degree or equivalent Experience with client interaction and willingness to travel Legal authorization to work in the U.S. without sponsorship Preferred Requirements
Policy & Claims Editing Expertise, including policy interpretation, claims editing, and error detection Contract Configuration & Provider Data Expertise, including contract terms, pricing methodologies, and provider lifecycle knowledge Familiarity with claims adjudication systems such as Facets, QNXT, Amisys Based in Chicago, IL, with flexibility to work from the office as needed Compensation & Benefits
Flexible PTO, volunteer time, paid holidays Own Your Day flexible work policy Competitive benefits: Medical, Dental, Vision, 401K Match Employee Stock Ownership Plan Paid parental leave, Life Insurance, STD, LTD Charitable matching, bonus programs, discounts The estimated base salary range is $105,000 - $125,000, with potential bonuses and a comprehensive benefits package. Actual compensation varies based on experience and qualifications. AArete is committed to diversity and inclusion, recognized as a top workplace and a leader in management consulting. We are an Equal Opportunity Employer.
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