Manager, Payment Intelligence

divh2Payment Intelligence Manager / h2pAArete is one-of-a-kind when it comes to consulting firm culture. Were 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 : Aret. And excellence is exactly what we strive for. Our success starts with enriching and empowering our people. From robust career development planning to competitive life and wellness benefits, AAretes Culture of Care takes a holistic approach to the employee experience. AAretians (our team members) are leaders at every level. You are encouraged to unlock your full potential by directly contributing to our mission and prioritizing space for personal development and fulfillment. / ppThe Role / ppHealth plans face continued challenges in reimbursing claims on-time and accurately. AAretes consulting service line, Payment Intelligence goes beyond typical payment integrity to ensure erroneous and inefficient payments are identified, rectified, and recouped to prevent them in the future. Our Payment Intelligence team addresses issues with payment policies, provider contracts, provider data, covered benefits, member eligibility and prior authorizations. / ppIn this role, the manager will be responsible for leading Payment Intelligence in client delivery. The position will report to a Payment Intelligence Managing Director. The individual will be the subject matter expert on strategies 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. / ppWork Youll Do / pulliProactively lead the team in understanding client needs and challenges, driving initiatives to solve issues and meet goals within specified timelines, while remaining deeply involved in the day-to-day aspects of the work / liliCollaborate with Managing Directors, Vice Presidents, and Directors to set project strategies and ensure alignment with client objectives, all while actively contributing to the project execution / liliOversee and manage the development, identification, and root cause of payment accuracy opportunities through remediation with client counterparts / liliLead and mentor teams in utilizing analytics to uncover claims payment opportunities through your knowledge of standard payment methodologies including Prospective Payment Systems (IPPS / OPPS), fee for service, Groupers, RUG, etc. / liliDrive the advancement of automation solutions for clients ensuring efficiency and scalability / liliStay ahead of regulatory changes, industry trends, and market shifts impacting health plan reimbursement and translate insights into actionable strategies / liliEnsure the quality and accuracy of client deliverables while managing stakeholder expectations / liliExercise excellent judgement and clear and direct communication in all aspects of your work / liliLead, mentor, and coach team members on client and internal projects, fostering a collaborative environment while maintaining active involvement in execution / liliOther duties as assigned / li / ulpRequirements / pulli6+ years of experience in a role within consulting, provider revenue cycle, a payment integrity vendor, and / or a payer organization / lili2+ years of management experience, with proven ability to lead and work closely with teams while also managing day-to-day responsibilities / liliExpertise in claims processing across multiple lines of business, including Medicare, Medicaid, ACA / Marketplace, Commercial, and Duals / liliExperience across various spend areas, including professional, ancillary, outpatient, and inpatient services / liliAbility to analyze claims to ensure accuracy and compliance / liliKnowledge of industry vendors and tools related to claims processing, provider data, and contract management / liliUnderstanding of end-to-end claims processes, including claims management, provider lifecycle, and network optimization / liliStrong professional communication skills, including written, verbal, interpersonal, and in-person presentation expertise / liliExperience coaching and mentoring team members / liliAdvanced proficiency utilizing Microsoft Excel and basic / intermediate SQL for data analysis, and PowerPoint / liliStrong analytical, data interpretation, and problem-solving skills / liliAbility to identify client savings opportunities and develop actionable business cases / liliBachelors degree or equivalent / liliDirect client interaction with possible travel to client locations / liliMust be legally authorized to work in the United States without the need for employer sponsorship / li / ulpPreferred Requirements / pulliPolicy Claims Editing Expertise / liulliInterpretation of healthcare policies and regulations / liliExperience in reimbursement policy writing and claims editing / liliProficiency in data mining to detect errors and inconsistencies / liliAbility to crosswalk and compare edits and policies / liliKnowledge of claims editing processes, including Prepay / Post-Pay, COB, Subrogation, Fraud Detection, and Medical Record Reviews / li / ulliContract Configuration Provider Data Expertise / liulliInterpretation of provider contract terms and pricing methodologies, including fee schedules, per diem, DRGs, cost-plus, and outlier payments / liliUnderstanding of contract carve-outs, including bundled services, readmissions, and reductions / liliExperience in contract pricing and claims reimbursement analysis / liliAbility to price and reprice claims based on contractual agreements / liliUnderstanding of provider TIN and NPI relationships / liliKnowledge of the provider lifecycle, including Credentialing, Data Management, Contracting, and Configuration / liliFamiliarity with network processes, including Optimization, Adequacy, and Pricing / li / ulliFamiliarity with claims adjudication systems (e.g., Facets, QNXT, Amisys, etc.) / liliBased in Chicago, IL, and flexible to work from our Chicago office as needed / li / ulpCompensation Benefits / pulliFlexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidays / liliOwn Your Day flexible work policy / liliCompetitive majority employer-paid benefits : Medical, Dental, Vision, 401K Match / liliGenerous paid parental leave options / liliEmployer paid Life Insurance, STD, LTD / liliCharitable contribution matching program / liliNew client commission opportunities and referral bonus program / liliBike share discount program / li / ulpThe estimated base salary range for this position is $130,000 $165,000. 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. / ppAArete will accept applications until the position is filled. The job posting will be removed once the role is no longer available. We put humans at the center of our work. Were a global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and strategy change for clients. Our cross-industry solutions are powered by a digital-first mindset, market intelligence, and data-driven approach to deliver purposeful change, actionable insights, and guaranteed results. But what sets us apart is our people. We are guided by our deeply embedded guiding principles : Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion. And weve been recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine. Weve earned a Great Place to Work Certification and been named a Worlds Best Management Consulting Firm by Forbes, Vaults Top 50 Firms to Work For, Crains Chicago Business Fast 50, Inc 5000s Fastest Growing Firms, and Consulting Magazines Fastest Growing Firms. / ppWe 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. / p / div