Job Family :
Operational Effectiveness Consulting
Travel Required : None
None
Clearance Required :
Ability to Obtain Public Trust
What You Will Do :
The position contributes to identification and resolution of payment integrity issues to support increasing the accuracy of claims adjudication and provider payments.
Oversees internal team(s) and work with multiple client groups. Decisions are typically related to the implementation of new / updated payment methodology or implementation of corrections to adjudication to align with TPA and provider contract terms.
Support technical / operational procedures and processes, and implements strategic plans, and improves performance.
What You Will Need :
- Bachelor's degree in business, healthcare administration, information systems or related field
- 5-8 or more years of proven leadership experience (Ideally leading a team within a Payment Integrity or Claims environment)
- 5 or more years of healthcare / managed care industry experience (Ideally in Claims and / or Payment Integrity)
- Proven experience and ability to determine the needed analytic approach, resources, and goals to meet business objectives
- Excellent communication and presentation skills to include the ability to communicate and present technical details to the client and leadership and / or Senior clients
What Would Be Nice To Have :
- Master's Degree in Business, Health Administration or related field
- Experience leading projects and processes
- Knowledge of coding and clinical payment methodology or other coding / clinical experience
- Ability to interpret federal regulations and operations manuals
- Experience in healthcare fraud investigations
The annual salary range for this position is $109,100.00-$163,700.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
What We Offer :
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include :
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
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