Healthcare Claims Payment Policy Managing Consultant

🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $113k - $188k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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Guidehouse

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2018

🏥 Healthcare

🎖️ Defense

📦 Logistics

💰 Grant on 2023-02

Healthcare • Defense • Logistics

Guidehouse is a global consultancy offering advisory, digital, and managed services across commercial and public sectors. It is purpose-built to support industries such as national security, financial services, healthcare, energy, and infrastructure. Guidehouse collaborates with leaders to navigate complexity and drives transformational changes that impact the future. Their expertise spans data analytics, digital technologies, risk management, and more, with a strong emphasis on sustainability and innovation.

📋 Description

• Support the payment policy workstream by setting priorities, managing the policy portfolio, aligning stakeholders, and driving timely reimbursement decisions • Draft, update, standardize, 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 implementation readiness, communications, testing support, reimbursement logic clarification, issue resolution, and stakeholder materials • Monitor 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 and implementation planning • Explain operational and payment impact to technical and non-technical stakeholders

🎯 Requirements

• 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 • Knowledge of 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 explain operational and payment impact to technical and non-technical stakeholders • Ability to obtain Public Trust clearance • Up to 25% travel required • Preference given to candidates local to the Washington, DC metro area

🏖️ Benefits

• 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