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Manager, Payment Intelligence

Manager, Payment Intelligence

AAreteDenver, CO, United States
7 days ago
Salary
$130,000.00–$165,000.00 yearly
Job type
  • Full-time
Job description

Description

Manager , Payment Intelligence

AArete is one-of-a-kind when it comes to consulting firm culture.

We're 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 : " Arete ." 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, AArete's "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.

The Role

Health plans face continued challenges in reimbursing claims on-time and accurately. AArete's 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 auth orizations.

In this role, the manager will be responsible for leading Payment Intelligence in client delivery. The position will report to a Payment Intelligence Manag ing 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.

Work You'll Do

  • Proactively 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
  • Collaborate 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
  • Oversee and manage the development, identification and root cause of payment accuracy opportunities through remediation with client counterparts
  • Lead and mentor teams in u tiliz ing 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.
  • Drive the advancement of a utomation solutions for clients ensuring efficiency and scalability
  • Stay ahead of regulatory changes, industry trends, and market shifts impacting health plan reimbursement and translate insights into actionable strategies
  • Ensure the quality and accuracy of c lient deliverables while managing stakeholder expectations
  • Exercise excellent judgement and clear and direct communication in all aspects of your work
  • Lead, mentor, and coach team members on client and internal projects, fostering a collaborative environment while maintaining active involvement in execution
  • Other duties as assigned

Requirements

  • 6 + years of experience in a role within consulting, provider revenue cycle, a payment integrity vendor, and / or a payer organization
  • 2+ years of management experience, with proven ability to lead and work closely with teams while also managing day-to-day responsibilities
  • Expertise in 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 analyze 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 and basic / intermediate SQL for data analysis , and PowerPoint
  • 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

    • Preferred Requirements

  • Policy & Claims Editing Expertise

    • I nterpretation 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

    • I nterpretation 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
  • E xperience 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
  • Familiarity with claims adjudication systems (e.g., Facet s , QNXT, Amisys, etc.)
  • Based in Chicago, IL, and flexible to work from our Chicago office as needed

    • Compensation & Benefits

  • 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
  • Employee Stock Ownership Plan
  • Generous paid parental leave options
  • E mployer 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 $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 Employee Stock Ownership Plan, 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.

    We put humans at the center of our work

    We're 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 we've been recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine.

    We've earned a Great Place to Work Certification and been named a World's Best Management Consulting Firm by Forbes, Vault's Top 50 Firms to Work For , Crain's Chicago Business Fast 50, Inc 5000's Fastest Growing Firms , and Consulting Magazine's Fastest Growing Firms .

    Learn more about our award-winning culture

    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.

    LI-DNI