Senior Solution Specialist, Payment Intelligence

AArete • Chicago, IL

2d • $105,000 - $125,000 • Hybrid

About The Position

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: “Areté.” 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 Payment Intelligence® goes beyond typical payment integrity to ensure erroneous and inefficient payments are identified, rectified, and recouped to prevent them in the future. In this role, the individual will be responsible for delivering claims analytics and post-pay data mining edits for client engagements . The position will report to a Payment Intelligence® Manager. 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.

Requirements

• 5+ years of experience in data management and analytics, with healthcare or insurance experience in a payer, provider, PBM, or analytics vendor setting preferred
• Experience leading a team or managing projects
• 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
• Strong professional communication skills, including written, verbal, interpersonal, and in-person presentation expertise
• Experience coaching and mentoring team members
• Advanced proficiency utilizing Microsoft Excel
• Strong analytical, data interpretation, and problem-solving skills
• Ability to identify client savings opportunities and develop actionable business cases
• Knowledge of healthcare, benefits, insurance industry, and managed care delivery system
• Passion for excellence and desire to help differentiate itself in the market
• Capability and interest to grow into larger, more strategic role over time
• Bachelor’s Degree or additional years of experience in lieu of degree
• Must be legally authorized to work in the United States without the need for employer sponsorship

Nice To Haves

• Policy & Claims Editing Expertise
• 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
• Contract Configuration & Provider Data Expertise
• 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.)
• Experience with SQL or other query languages
• Based in Chicago, IL, and flexible to work from our Chicago office as needed

Responsibilities

• Lead the development, identification and root cause of payment accuracy opportunities through remediation with client counterparts
• Utilize 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.
• Support the advancement of automation
• Staying up to date on current events, changes in regulatory requirements and market trends impacting health plan reimbursement
• Prepare client ready deliverables
• Exercise excellent judgement and clear and direct communication in all aspects of your work
• Other duties as assigned

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 251-500 employees