Healthcare Claims Payment Policy Managing Consultant

🕒 Agosto 16

⚔️ Virginia – Remoto

⚔️ Virginia – Remote

💵 $113.000 - $188.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

💼 Consultor

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

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Guidehouse

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 2018

🏥 Saúde

🎖️ Defesa

📦 Logística

💰 Grant em 2023-02

Healthcare • Defense • Logistics

A Guidehouse é uma consultoria global que oferece serviços de consultoria, digitais e gerenciados nos setores comercial e público. Ela é projetada para apoiar indústrias como segurança nacional, serviços financeiros, saúde, energia e infraestrutura. A Guidehouse colabora com líderes para navegar na complexidade e impulsionar mudanças transformacionais que impactam o futuro. Sua expertise abrange análise de dados, tecnologias digitais, gestão de riscos e mais, com forte ênfase em sustentabilidade e inovação.

Descrição

• Support the payment policy workstream by setting priorities, managing the policy portfolio, aligning stakeholders, and driving timely reimbursement decisions. • Draft, standardize, write, update, and maintain payment policies, reimbursement guidance, FAQs, briefings, and implementation materials. • Translate reimbursement policy, payer guidance, coding requirements, and stakeholder decisions into claims rules, edits, bundles, business requirements, payment controls, fee schedules, and operational decision logic. • Coordinate readiness, communications, testing support, reimbursement logic clarification, issue resolution, and stakeholder materials to support implementation and adoption. • Track federal, state, and commercial payer updates, coding changes, fee schedule changes, and provider billing guidance. • Define data needs, review claims and reimbursement data, assess payment impacts, and use findings to inform policy decisions, implementation planning, and stakeholder discussions. • Travel required up to 25%.

🎯 Requisitos

• 5+ years in payment policy, reimbursement policy, payment integrity, claims, revenue cycle, fee schedule development, or healthcare reimbursement. • Experience drafting, standardizing, implementing, and maintaining payment policies, reimbursement guidance, provider billing guidance, and stakeholder communications. • Knowledge of Medicare, Medicaid, TRICARE, commercial payer reimbursement policy, provider billing standards, fee schedules, claims adjudication rules, and healthcare claims coding concepts including CPT, HCPCS, ICD, revenue codes, DRGs, modifiers, bundled payments, unlisted codes, non-reimbursable codes, and claims edits. • Ability to translate reimbursement policy and payer guidance into claims rules, edits, bundles, business requirements, payment controls, operational decision logic, and defensible payment integrity approaches. • Ability to translate policy questions into data requests, interpret claims and reimbursement data, and clearly explain operational and payment impact to technical and non-technical stakeholders. • Ability to obtain Public Trust clearance. • Experience working in a large federal health, payer, or provider environment with complex reimbursement policies, multiple stakeholders, and cross-functional implementation partners. • Experience supporting third-party administrator or claims operations implementation. • Experience conducting claims, reimbursement, cost, or payment impact analyses using Excel, Power BI, Tableau, SQL, or similar tools. • Experience leading a team or workstream. • Preference will be given to candidates local to the Washington, DC metro area.

🏖️ Benefícios

• Medical, Rx, Dental & Vision Insurance • Personal and Family Sick Time & Company Paid Holidays • Position may be eligible for a discretionary variable incentive bonus • Parental Leave and Adoption Assistance • 401(k) Retirement Plan • Basic Life & Supplemental Life • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts • Short-Term & Long-Term Disability • Student Loan PayDown • Tuition Reimbursement, Personal Development & Learning Opportunities • Skills Development & Certifications • Employee Referral Program • Corporate Sponsored Events & Community Outreach • Emergency Back-Up Childcare Program • Mobility Stipend • Flexible benefits package

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