About this opportunity
AArete lists this Solution Specialist, Payment Intelligence opportunity in chicago, Illinois. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Description
Solution Specialist, 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 Europe. Our name comes from the Greek word for excellence: "Arete." And excellence is exactly what we strive for.
We're celebrating our fourth year as one of Forbes' World's Best Management Consulting Firms - and our success starts with 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 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.
In this role, the individual will be responsible for delivering claims analytics and post-pay data mining edits for client engagements. The position will reporttoa Payment IntelligenceManager. The individual will be the subject matter expert on strategies to help our clients ensure proper claims paymentthrough the use of(1) claims analytics, (2) process improvements, (3) integration of automation/technology, and (4) configurations setups. This role will support the internal development of Payment Intelligence initiatives.
Work You'll Do
Support the development, identification and analysisof payment accuracy opportunities through remediation
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
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
Requirements
2+ years of experience in payment integrity, healthcare analytics,orpayer operations
Foundational knowledge of claims processing across multiple lines of business, including Medicare, Medicaid, ACA/Marketplace, Commercial, and Duals
Experience across various spend areas (professional, ancillary, outpatient, and inpatient), familiarity with modifiers, place of service codes, and NPI/TIN relationships
Ability to identify incorrect claims payments
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
Advanced proficiency utilizing Microsoft Excel
Strong analytical, data interpretation, and problem-solving skills
Ability to identify client savings opportunities and develop actionable business cases
Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules
Bachelor's Degree oradditionalyears of experience in lieu of degree
Must be legally authorized to work in the United States without the need for employer sponsorship
Preferred Requirements
Policy & Claims Editing ExpertiseResearch 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 ExpertiseInterpretation 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
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
Experience in reimbursement policy
Knowledge of COB, Subrogation, Fraud Detection, and Medical Record Reviews
Experience with financial impact modeling, savings forecasting, and ROI analysis
Exposure to AI/ML models for aberrant billing pattern detection
Understanding of EDI formats (837/835) and how errors propagate through the claim lifecycle
Familiarity with industry vendors
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
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
The estimated base salary range for this position is $75,000 - $105,000. 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.
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.
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Who can apply
Review the original listing for work authorization, qualifications and employer requirements.