Job Family :

Operational Effectiveness Consulting

Travel Required :

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

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.