Healthcare Claims Analytics Managing Consultant

Job Family:

Travel Required:

Clearance Required:

What You Will Do:

We are seeking experienced managers with subject matter expertise in healthcare claims data including knowledge of validating loading processing and analyzing healthcare claims data preferably a variety of claims (Medicare Medicaid VA Commercial). The role will lead strategy analytics and audit initiatives aimed at enhancing payment integrity programs reducing improper payments identifying fraud and anomalies and determining payment trends that inform policy and drive cost savings. The successful candidate will:

• Serve as a strategic leader and thought partner in claims analytics payment integrity and reimbursement policy.
• Lead assessments of business and technical requirements forclaims auditspost-payment analysis andpayment integrity strategies.
• Interpret complex healthcare data to identify anomalies trends and policy gaps.
• Translate insights into actionable business requirements and policy recommendations.
• Stay current onstate-level healthcare transformation effortsand industry coding standards.
• Oversee development ofdashboardsreports andanalytics toolsto support improper payment reduction.
• Apply general coding skills to build scalable solutions and support team members in technical execution.
• Direct in-depthdata modelingscenario analysis claims analytics or health system performanceto inform strategic decisions.
• Provide hands-on training and mentorship to junior consultants and analysts.
• Facilitateknowledge transfer promotecontinuous improvement and enhanceaudit readinessacross teams.
• Foster a collaborative culture that encourages innovation and career growth.
• Manage complex client engagements from inception to completion ensuring high-quality outcomes.
• Lead business development efforts including proposal creation and relationship management.
• Support internal strategy initiatives including offering development and community engagement.

What You Will Need:

• Bachelors degreefrom an accredited university; advanced degree preferred (e.g. MPH MHA MBA JD or related).
• 5 years of experiencein healthcare data analytics consulting or claims operations preferably with a focus onpayment integrityimproper payment detection andclaims reimbursement.
• 3 years of experienceleading teams or projects involving healthcare claims data medical coding auditing or post-payment analysis.
• Proven ability totranslate complex data insights into strategic business requirementsand policy recommendations.
• Demonstrated expertise instate health agenciesMedicareMedicaidVA and healthcare reform initiatives.
• Strongfinancial and quantitative analysis skills including experience inbusiness case developmentscenario modeling andcontract strategy alignment.
• Proficiency inPower BITableau and/orAlteryx with hands-on experience developing dashboards and analytics tools.
• Excellentwritten and verbal communication skills with the ability to lead client engagements manage expectations and present findings to diverse stakeholders.
• Experience intraining and mentoringjunior staff facilitatingknowledge transfer and building team capabilities in claims analytics and payment integrity.
• Ability to Obtain a Public Trust clearance (US Citizenship required)

What Would Be Nice To Have:

• Masters or Advanced Degreein Public Health Health Administration Business Law Data Science or a related field.
• Deep understanding ofreimbursement methodologiesprovider contract structures andclaims processing workflows including resolution practices and audit strategies.
• Experience applyingadvanced data analyticsto healthcare claims including anomaly detection trend analysis and improper payment identification.
• Demonstratedstrategic problem-solvingability with experience managing discrete projects initiatives and cross-functional teams.
• Strongself-managementand organizational skills with the ability to lead engagements from design through implementation.
• Track record of supporting business development proposal writing and relationship management in a consulting or advisory capacity.

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 Opportunity EmployerProtected Veterans Individuals with Disabilities 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- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @ or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse please report the matter to Guidehouses Ethics Hotline. If you want to check the validity of correspondence you have received please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicants dealings with unauthorized third parties.

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.