Healthcare Claims Payment Policy Managing Consultant
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Healthcare claims policy consultant improving reimbursement accuracy for Guidehouse’s government and commercial clients. Translating payer policy, coding, and claims data into operational payment rules and implementation guidance.
Responsibilities:
- Support the payment policy workstream by setting priorities, managing the policy portfolio, aligning stakeholders, and driving timely reimbursement decisions
- Draft, update, standardize, and maintain payment policies, reimbursement guidance, FAQs, briefings, and implementation materials
- Translate reimbursement policy, payer guidance, coding requirements, and stakeholder decisions into claims rules, edits, bundles, business requirements, payment controls, fee schedules, and operational decision logic
- Coordinate implementation readiness, communications, testing support, reimbursement logic clarification, issue resolution, and stakeholder materials
- Monitor federal, state, and commercial payer updates, coding changes, fee schedule changes, and provider billing guidance
- Define data needs, review claims and reimbursement data, assess payment impacts, and use findings to inform policy decisions and implementation planning
- Explain operational and payment impact to technical and non-technical stakeholders
Requirements:
- 5+ years in payment policy, reimbursement policy, payment integrity, claims, revenue cycle, fee schedule development, or healthcare reimbursement
- Experience drafting, standardizing, implementing, and maintaining payment policies, reimbursement guidance, provider billing guidance, and stakeholder communications
- Knowledge of Medicare, Medicaid, TRICARE, commercial payer reimbursement policy, provider billing standards, fee schedules, claims adjudication rules, and healthcare claims coding concepts
- Knowledge of CPT, HCPCS, ICD, revenue codes, DRGs, modifiers, bundled payments, unlisted codes, non-reimbursable codes, and claims edits
- Ability to translate reimbursement policy and payer guidance into claims rules, edits, bundles, business requirements, payment controls, operational decision logic, and defensible payment integrity approaches
- Ability to translate policy questions into data requests, interpret claims and reimbursement data, and explain operational and payment impact to technical and non-technical stakeholders
- Ability to obtain Public Trust clearance
- Up to 25% travel required
- Preference given to candidates local to the Washington, DC metro area
Benefits:
- 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
- Flexible benefits package
Similar Jobs
IT Consultant – Digital Product Development
IT Consultant developing customized low-code digital products for TIVITY’s business digitization platform. Translating customer visions into user stories, wireframes, MVPs, workflows, and validated solutions.
Utilization Management Clinical Consultant
Utilization management consultant reviewing medical necessity, records, and prior authorizations for CVS Health. Improving healthcare quality, resource utilization, and benefit effectiveness remotely in Louisiana.
Human Capital Consulting Consultant
Human capital consultant evaluating client organizations and recommending structural, process, and development improvements. Leading engagements, training initiatives, and change-management solutions aligned with clients’ business goals.
Senior Travel Consultant
Senior Travel Consultant booking compliant business travel for AbbVie through BCD Travel. Managing reservations, travel policies, regulations, fares, and client service remotely.
Luxury Travel Consultant – Commission Based
Luxury Travel Consultant selling bespoke, high-ticket travel experiences for private groups and corporate clients. Managing consultations, proposals, sales, and client relationships remotely.
Senior MM Consultant – Dedicated
Consultor SAP MM sênior atendendo AMS e processos de recebimento fiscal brasileiro na SEIDOR. Atuando com GRC/DRC Inbound, integrações MM, requisitos de negócio e especificações ABAP.
Utilization Management Nurse Consultant
Utilization Management Nurse Consultant reviewing clinical information for CVS Health members. Coordinating care and supporting quality healthcare decisions remotely from Pennsylvania.
Solution Consultant
Solution Consultant helping cisbox digitize Procure-to-Pay, procurement, accounts payable, and banking processes. Bridging sales, product management, and customers through workshops, demos, and solution design.
UKG WFM Technical Consultant – Independent Contractor
UKG WFM consultant delivering payroll and timekeeping implementations for HCM Unlocked clients. Managing complex projects, configurations, troubleshooting, and client relationships independently.
Personal Cruise Consultant
Personal Cruise Consultant selling Norwegian Cruise Line vacations directly to consumers. Managing leads, recommending cruise products, and closing sales while meeting customer retention and revenue goals.
Berater Datenschutz, Privacy Consultant
Datenschutzberater:in bei tacticx Consulting, einem deutschen Beratungsunternehmen für Datenschutz und Informationssicherheit. Planung von Audits, Risikoanalysen und Compliance-Projekten für Kunden.
Travel Consultant, Amadeus
Travel Consultant using Amadeus to arrange corporate travel for BCD Travel clients. Advising travelers on policies, fares, regulations, and reservation changes.
VIP Travel Consultant
VIP travel consultant serving executive travelers for BCD Travel, a corporate travel management company. Handling reservations, policy guidance, regulations, and high-touch consultation remotely.
Travel Consultant II
Travel Consultant II helping United States clients book compliant business travel at BCD Travel. Handling reservations, travel policies, fares, exchanges, regulations, and client process improvements remotely.
Senior Cloud Platform Consultant
Cloud Platform Senior Consultant operating AWS/GCP databases and streaming infrastructure for Arity, Allstate’s transportation data company. Ensuring resilient, observable, cost-efficient platforms powering mobility insights.
Principal Clinical Data Standards Consultant
Principal consultant developing CDISC-compliant data standards for ICON’s global clinical research organization. Advising sponsors, governing standards, and delivering training across clinical trials.
Franchise Business Consultant
Franchise Business Consultant improving Waxing the City franchisee performance for Purpose Brands’ wellness franchise portfolio. Driving multi-unit growth through operational consulting, training, action plans, and field support.
Provider Partner Consultant
Provider Partner Consultant strengthening Oklahoma dental provider networks for Sun Life’s DentaQuest. Educating offices, improving claims technology adoption, and expanding access to quality care.
Desk Property Lead Consultant
Desk claims consultant investigating and settling complex homeowners losses for National General, a personal-lines insurance provider. Handling large property claims, estimates, escalations, and junior-staff mentorship.
Senior Consultant – Technology Transformation Advisory
Senior consultant advising US clients on technology transformation at 3Cloud. Developing roadmaps, business cases, and modernization strategies across cloud, data, AI, and enterprise operations.