Healthcare Claims Analytics Consultant — Remote Options

Guidehouse; Arlington (VA); Presencial; USD 98.000 - 163.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical Insurance

Mobility Stipend

401(k) Plan

Parental Leave

Descripción de la vacante

Guidehouse is seeking Consultants with foundational healthcare claims data experience to validate, load, process, and analyze claims from Medicare, Medicaid, VA, and Commercial payers. You will help develop claims analyses and audits to reduce improper payments, identify potential fraud, and uncover patterns that inform policy and cost-saving strategies.

You will build dashboards and reports, translate insights into business requirements for analytics tools, and collaborate with internal and

Formación

• Bachelor's degree required.
• 3+ years of professional experience with datasets to derive insights and solve problems.
• Proficiency in SQL, Python, or R and experience building dashboards and data visualizations.
• Exposure to healthcare data analytics and claims data.

Responsabilidades

• Demonstrate working knowledge of claims datasets and reimbursement concepts.
• Assist in gathering and interpreting business and technical requirements for claims audits and post-payment analysis.
• Conduct data-driven and qualitative research to support payment policy evaluation and anomaly detection.
• Build dashboards and reports using coding tools to visualize claims trends and audit findings.
• Research and summarize industry-standard coding rules and contribute to reimbursement policy discussions.
• Document findings and support the development of recommendations and follow-up actions.
• Contribute to analytics that identify payment trends, errors, and improper payment risks.
• Stay informed on state healthcare reform efforts and emerging policy changes.
• Translate research and claims review insights into business requirements for analytics tools.
• Respond to inquiries and disputes related to claims edits and policy interpretation.
• Collaborate with internal teams and external stakeholders to support project delivery.
• Support project management activities and contribute to client interactions.

Conocimientos

SQL

Python

R

Dashboards

Data analytics

Attention to detail

Educación

Bachelor's degree

Herramientas

Power BI

Tableau

Descripción del empleo

Guidehouse is seeking Consultants with foundational healthcare claims data experience to validate, load, process, and analyze claims from Medicare, Medicaid, VA, and Commercial payers. You will help develop claims analyses and audits to reduce improper payments, identify potential fraud, and uncover patterns that inform policy and cost-saving strategies.

You will build dashboards and reports, translate insights into business requirements for analytics tools, and collaborate with internal and