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Senior Consultant
2 months ago
Senior Consultant - Payment Intelligence
AArete is one-of-a-kind when it comes to consulting firm culture. We are 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.
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 leading Payment Intelligence in client delivery. The position will report into a Payment Intelligence Manager. 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.
Work You'll Do
Lead the development, identification, and root cause 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 judgment and clear and direct communications in all aspects of your work
Requirements
Minimum 4+ 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
Experience coaching and mentoring team members
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
Bachelor's degree or equivalent
Direct client interaction, including possible travel to client location
Must be legally authorized to work in the United States without the need for employer sponsorship
Preferred Requirements
Based in Chicago, IL and flexible to work from our Chicago office as needed
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