AArete · 3 weeks ago
Consultant, Payment Intelligence
Chicago, IL
Full-time
Hybrid
Entry, Mid Level
$84K/yr - $102K/yr
2+ years expAArete is a global, innovative management and technology consulting firm specializing in strategic profitability improvement and digital transformation. The Consultant, Payment Intelligence role involves delivering Payment Intelligence services to clients, focusing on ensuring accurate claims payments through analytics, process improvements, and technology integration.
Management Consulting
No H1B
Responsibilities
Support the development, identification and analysis of payment accuracy opportunities through remediation with client counterparts
Utilize analytics to identify claims payment opportunities through your knowledge of standard payment methodologies including Prospective Payment Systems (IPPS/OPPS), fee for service, Groupers, RUG, etc
Support process improvements and automation initiatives for clients
Conduct research on current events, changes in regulatory requirements and market trends impacting health plan reimbursement
Contribute to the preparation of client ready deliverables with clear and actionable insight
Exercise sound judgement and clear and direct communication in all aspects of your work
Other duties as assigned
Qualification
Required
2+ years of experience in a role within consulting, provider revenue cycle, a payment integrity vendor, and/or a payer organization
Foundational knowledge of 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 identify and analyze mispaid 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
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
Research and interpretation 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
Interpretation 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
Experience 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., Facets, QNXT, Amisys, etc.)
Based in Chicago, IL, and flexible to work from our Chicago office as needed
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
Generous paid parental leave options
Employer paid Life Insurance, STD, LTD
Charitable contribution matching program
New client commission opportunities and referral bonus program
Bike share discount program
Company
AArete
AArete is a management consulting company specializing in operational performance improvement and strategic cost reduction services.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2025-06-24Private Equity
Leadership Team
Loren Trimble
Chief Executive Officer
Recent News
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