Consultant, Payment Intelligence

• 2+ years of experience in a role within consulting, provider revenue cycle, a payment integrity vendor, and/or a payer organization
• Foundational knowledge of claims processing across multiple lines of business, including Medicare, Medicaid, ACA/Marketplace, Commercial, and Duals
• Experience across various spend areas, including professional, ancillary, outpatient, and inpatient services
• Ability to identify and analyze mispaid claims to ensure accuracy and compliance
• Knowledge of industry vendors and tools related to claims processing, provider data, and contract management
• Understanding of end-to-end claims processes, including claims management, provider lifecycle, and network optimization
• Strong professional communication skills, including written, verbal, interpersonal, and in-person presentation expertise
• Experience coaching and mentoring team members
• Advanced proficiency utilizing Microsoft Excel
• Strong analytical, data interpretation, and problem-solving skills
• Ability to identify client savings opportunities and develop actionable business cases
• Bachelor’s Degree or equivalent
• Direct client interaction with possible travel to client locations
• Must be legally authorized to work in the United States without the need for employer sponsorship

• Policy & Claims Editing Expertise Research and interpretation of healthcare policies and regulations Experience in reimbursement policy writing and claims editing Proficiency in data mining to detect errors and inconsistencies Ability to crosswalk and compare edits and policies Knowledge of claims editing processes, including Prepay/Post-Pay, COB, Subrogation, Fraud Detection, and Medical Record Reviews
• Research and interpretation of healthcare policies and regulations
• Experience in reimbursement policy writing and claims editing
• Proficiency in data mining to detect errors and inconsistencies
• Ability to crosswalk and compare edits and policies
• Knowledge of claims editing processes, including Prepay/Post-Pay, COB, Subrogation, Fraud Detection, and Medical Record Reviews
• Contract Configuration & Provider Data Expertise Interpretation of provider contract terms and pricing methodologies, including fee schedules, per diem, DRGs, cost-plus, and outlier payments Understanding of contract carve-outs, including bundled services, readmissions, and reductions Experience in contract pricing and claims reimbursement analysis Ability to price and reprice claims based on contractual agreements Understanding of provider TIN and NPI relationships Knowledge of the provider lifecycle, including Credentialing, Data Management, Contracting, and Configuration Familiarity with network processes, including Optimization, Adequacy, and Pricing
• Interpretation of provider contract terms and pricing methodologies, including fee schedules, per diem, DRGs, cost-plus, and outlier payments
• Understanding of contract carve-outs, including bundled services, readmissions, and reductions
• Experience in contract pricing and claims reimbursement analysis
• Ability to price and reprice claims based on contractual agreements
• Understanding of provider TIN and NPI relationships
• Knowledge of the provider lifecycle, including Credentialing, Data Management, Contracting, and Configuration
• Familiarity with network processes, including Optimization, Adequacy, and Pricing
• Experience with SQL or other query languages
• Familiarity with claims adjudication systems (e.g., Facets, QNXT, Amisys, etc.)
• Based in Chicago, IL, and flexible to work from our Chicago office as needed

• Flexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidays
• Own Your Day flexible work policy
• Competitive majority employer-paid benefits: Medical, Dental, Vision, 401K Match
• Generous paid parental leave options
• Employer paid Life Insurance, STD, LTD
• Charitable contribution matching program
• New client commission opportunities and referral bonus program
• Bike share discount program

The 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.

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We are an Equal Employment Opportunity Employer

All 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.

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