Senior Healthcare Claims Policy Architect

US101 Guidehouse Inc.; Tysons (VA); Presencial; USD 113.000 - 188.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Holidays

Bonus potential

Parental leave

401k plan

Life insurance

HSA

Discounted tuition/learning

Disability insurance

Tuition reimbursement

Learning opportunities

Employee referral program

Mobility stipend

Back-up childcare

Descripción de la vacante

Guidehouse Inc. is seeking a Healthcare Claims Payment Policy expert to draft, standardize, implement, and maintain payment policies in a large payer environment.

You will translate research and policy decisions into operational guidance for claims adjudication and stakeholder understanding. The ideal candidate has extensive reimbursement policy experience, including Medicare, Medicaid, TRICARE, and commercial payer policies, with strong data interpretation and cross‑functional collaboration

Formación

• 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 including CPT, HCPCS, ICD, revenue codes, DRGs, modifiers, bundled payments, unlisted codes, non-reimbursable codes, and claims edits.

Responsabilidades

• Support the payment policy workstream.
• Set priorities, manage the policy portfolio, align stakeholders, and drive timely decisions that support accurate and consistent reimbursement.
• Draft and standardize payment policies.

Conocimientos

Payment policy

Reimbursement policy

Stakeholder communications

Claims data analysis

Policy drafting

Herramientas

Excel

Power BI

Tableau

SQL

Descripción del empleo

Guidehouse Inc. is seeking a Healthcare Claims Payment Policy expert to draft, standardize, implement, and maintain payment policies in a large payer environment.

You will translate research and policy decisions into operational guidance for claims adjudication and stakeholder understanding. The ideal candidate has extensive reimbursement policy experience, including Medicare, Medicaid, TRICARE, and commercial payer policies, with strong data interpretation and cross‑functional collaboration