Healthcare Claims Consultant

Consulting - US Chicago, Illinois New York, New York Los Angeles, California


Description

Payment Intelligence Consultant

We’re passionate, we’re collaborative and we are growing.

AArete is looking for an experienced Payment Intelligence professional. You are highly analytical with an entrepreneurial spirit and commitment to excellence. You strive in a team environment and have the ability to flip tasks and priorities midstream because you love an exciting challenge. The bar is set high at AArete. There is a lot to do around here and you love getting the job done right.

Why AArete? AArete’s mission is to increase client profitability while improving the capabilities of our clients’ people. We believe that any organization can succeed by enriching and empowering its people. Our own people empower our vision to be a premier global management consulting firm that Fortune 500 and leading organizations trust. Derived from the Greek word “arete,” embodying excellence, goodness and virtue, an extra “A” was added to honor our founder’s original partnership at Arthur Andersen & Co. AArete is guided by the following principles: Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion. 

It is an exciting time to join the AArete team. Come join the company named in Vault’s Top 50 Firms to Work For, Crain's Chicago Business Fast 50 for a 3rd year, Inc 5000’s Fastest Growing Firms list for the 4th consecutive year and Consulting Magazine's Fastest Growing Firms for the 4th consecutive year.

The Role. Many vendors provide on-going payment integrity services; however, AArete’s Payment Intelligence™ ensures erroneous payments are identified, understood, recouped and rectified to prevent them in the future. Payment Intelligence™ addresses provider billing and health plan payment inaccuracies resulting from issues with payment policies, provider contracts, provider data, covered benefits, member eligibility and prior authorizations.

In this role, the individual will be responsible for supporting Payment Intelligence in client delivery. The position will report into a Payment Intelligence Manager with dotted lines to the client engagement managers. In this position, the individual will be the subject matter expert on practices 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) configurations setups. This role will also support the internal development of Payment Intelligence initiatives.

Primary Responsibilities:

  • Lead the development, identification and root causing of payment accuracy opportunities through enhancing tactics and communicate/coordinate remediation with client counterparts
  • Utilize claims analytics to uncover payment accuracy opportunities through your knowledge of standard payment methodologies including Prospective Payment Systems (IPPS/OPPS), fee for service, Groupers, RUG, etc.
  • Support the advancement of AArete’s Payment Intelligence initiatives to drive greater automation to claims payment
  • Identify areas of opportunity for Payment Intelligence by staying up to date on current events, changes in regulatory requirements and market trends
  • Prepare deliverables for final review with engagement manager
  • Exercise excellent judgement and clear and direct communications in all aspects of your work

Requirements:

  • Minimum 3+ years experience in healthcare payment accuracy related role either in consulting, provider revenue cycle, a payment integrity/accuracy vendor, or within a payer organization
  • Strong professional communication skills including written, verbal, interpersonal and in-person presentation expertise
  • Advanced proficiency utilizing Microsoft Excel and basic/ intermediate SQL for data analysis
  • Strong analytical, data analysis and interpretation skills; and ability to learn methodologies to identify client savings opportunities and put together an actionable business case
  • Enthusiasm for joining a fast-paced, high growth company and be a part of the business architecture of technology applications and tools
  • Interest in taking advantage of career advancement opportunities within AArete and a growing solution offering
  • Bachelor’s degree or equivalent
  • Willingness and ability to travel commensurate with industry standards – typical travel in this role can be 50% - 90%+, however as we adjust to a Post-COVID environment, we anticipate travel to be limited and reduced