Healthcare Claims Payment Policy Managing Consultant

🕒 August 16

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $113k - $188k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 31%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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, 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%.

🎯 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 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.

🏖️ 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