Talent.com
Manager, Solution Specialist,Payment Intelligence
Manager, Solution Specialist,Payment IntelligenceAArete • Vienna, VA, United States
Manager, Solution Specialist,Payment Intelligence

Manager, Solution Specialist,Payment Intelligence

AArete • Vienna, VA, United States
11 hours ago
Job type
  • Full-time
Job description

Description

Manager, Solution Specialist,Payment Intelligence

AArete is one-of-a-kind when it comes to consulting firm culture.

We'rea global, innovative management and technology consulting firm, with offices in the U.S., India, and the U.K. Our name comes from the Greek word for excellence : "Arete." And excellence is exactly what we strive for.

Our success starts with enriching and empowering our people. From robust career development planning to competitive life and wellness benefits,AArete's"Culture of Care" takesa holistic approachto the employee experience.

AAretians(our team members) are leaders at every level. You are encouraged to unlock your full potential by directly contributing to our mission and prioritizing space for personal development and fulfillment.

The Role

Health plans face continued challenges in reimbursing claimson timeand accurately.AArete'sconsulting service line,Payment Intelligence,goes beyond typical payment integrity to ensureerroneousand inefficient payments areidentified, rectified, andrecouped toprevent them in the future.

In this role, the individual will lead client engagements focused on claims analytics, overpayment identification, and post-pay data mining strategies. The Manager will oversee a team of analysts and consultants to design and implement solutions that improve claims payment accuracy and operational efficiency. This role will report to a Payment Intelligence Director and will play a key role in supporting internal capability development, client relationship management, and the growth of AArete's Payment Intelligence practice.

WorkYou'llDo

  • Lead day-to-day delivery activities across multiple projects, ensuring work quality, timeliness, and alignment with client expectations
  • Guide the design, development, and validation of data-driven analyses to identify payment inaccuracies, process inefficiencies, and potential recoveries
  • Translate analytical findings into actionable insights and strategic recommendations for senior client stakeholders
  • Direct and manage team members in claims analytics, policy interpretation, and process improvement
  • Develop project plans, timelines, and deliverables while managing competing priorities across project teams and clients
  • Oversee automation and tool-based initiatives that enhance claims review accuracy and operational scalability
  • Support business development activities including proposal writing, project scoping, and client presentations
  • Maintain awareness of regulatory changes, emerging trends, and market dynamics impacting payment integrity
  • Exercise strong communication, leadership, and client-facing presence across all engagements
  • Other duties as assigned

Requirements

  • 7+ years of experience in payment integrity, healthcare analytics, or payer operations with a Bachelor's Degree, or 10+ years of equivalent experience without a degree
  • Comprehensive understanding of healthcare claims and reimbursement methodologies across Medicare, Medicaid, ACA / Marketplace, Commercial, and Duals
  • Demonstrated experience managing analytics or consulting teams delivering payment integrity or cost containment solutions
  • Proficiency in claims data analytics and identification of mispaid claims to ensure accuracy and compliance
  • Familiarity with spend categories (professional, ancillary, outpatient, inpatient), modifiers, and place of service codes
  • Knowledge of industry tools related to claims editing, provider data, and contract management
  • Strong communication, presentation, and stakeholder management skills
  • Advanced proficiency in Microsoft Excel or working knowledge of SQL or other query languages
  • Strong analytical, problem-solving, and storytelling abilities to translate complex data into actionable recommendations
  • Knowledge of the healthcare, benefits, and insurance industries, as well as managed care delivery systems
  • Passion for excellence and desire to help differentiate AArete in the market
  • Capability and interest to grow into larger, more strategic leadership role over time
  • Must be legally authorized to work in the United States without the need for employer sponsorship
  • Preferred Requirements

  • Policy & Claims Editing Expertise
  • Research and interpretation of healthcare policies and regulations

  • Experience in reimbursement policy writing and claims editing
  • Proficiencyin data mining to detect errors and inconsistencies
  • Ability to crosswalk and compare edits and policies
  • Knowledge of claims editing processes, including Prepay / Post-Pay, COB, Subrogation, Fraud Detection, and Medical Record Reviews
  • Contract Configuration& Provider Data Expertise
  • Interpretation of provider contract terms and pricing methodologies, including feeschedules,per diem, DRGs, cost-plus, and outlier payments

  • Understanding of contract carve-outs, including bundled services,readmissions, and reductions
  • Experience in contract pricing and claims reimbursement analysis
  • Ability to price and reprice claims based on contractual agreements
  • Understanding of provider TIN and NPI relationships
  • Familiarity with network processes, including Optimization, Adequacy, and Pricing
  • Familiarity with claims adjudication systems (e.g.,Facets, QNXT,Amisys, etc.)
  • Based in Chicago, IL,and flexible to work from our Chicago office as needed
  • Compensation & Benefits

  • Flexible PTO, monthly half-day refuels, volunteer time off, 10 paid holidays
  • Own Your Day flexible work policy
  • Competitive majority employer-paid benefits : Medical, Dental, Vision, 401K Match
  • Generous paid parental leave options
  • Employer paid Life Insurance, STD, LTD
  • Charitable contribution matching program
  • New client commission opportunities and referral bonus program
  • Bike share discount program
  • The estimated base salary range for this position is $125,000 - $165,000. In addition to this base salary, individuals may be eligible for an annual discretionary bonus. This range is a part of a competitive, total compensation package together with our majority employer-paid benefits, and incentive pay for eligible roles. Please note that this range is a guideline and individual total compensation may vary due to numerous factors including but not limited to experience level, certifications, and other relevant business considerations.

    AArete will accept applications until the position is filled. The job posting will be removed once the role is no longer available.

    We put humans at the center of our work

    We're a global management and technology consulting firm specializing in strategic profitability improvement, digital transformation, and strategy & change for clients. Our cross-industry solutions are powered by a digital-first mindset, market intelligence, and data-driven approach to deliver purposeful change, actionable insights, and guaranteed results.

    But what sets us apart is our people. We are guided by our deeply embedded guiding principles : Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion.

    And we've been recognized as a top firm to work for by companies like Forbes, Top Workplaces Chicago Tribune, and Consulting Magazine.

    We've earned a Great Place to Work Certification and been named a World's Best Management Consulting Firm by Forbes, Vault's Top 50 Firms to Work For, Crain's Chicago Business Fast 50, Inc 5000's Fastest Growing Firms, and Consulting Magazine's Fastest Growing Firms.

    Learn more about our award-winning culture

    We are an Equal Employment Opportunity Employer

    All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

    #LI-DNI

    Create a job alert for this search

    Intelligence Manager • Vienna, VA, United States

    Related jobs
    RN Clinical Manager

    RN Clinical Manager

    Monocacy Surgery Center (11305) • FREDERICK, Maryland, United States
    Full-time
    Monocacy Surgery Center is hiring a full time RN Clinical Manager.The RN Clinical Manager directs, coordinates and controls the multi-disciplinary activities for patients undergoing surgical interv...Show more
    Last updated: 30+ days ago • Promoted
    Insider Threat Program Systems SME

    Insider Threat Program Systems SME

    Leidos • Oxon Hill, MD, US
    Full-time
    The Digital Modernization Sector at Leidos currently has an opening for a Systems Management SME supporting the HEITS Contract as part of an Insider Threat Program (ITP). This is an exciting opportu...Show more
    Last updated: 30+ days ago • Promoted
    Telemedicine Physician

    Telemedicine Physician

    QuickMD • Jefferson, MD, US
    Full-time
    QuickMD is a leading telemedicine provider, delivering high-quality virtual care across 44 states.Since our founding in 2019, we have helped more than 100,000 patients access essential medical trea...Show more
    Last updated: 30+ days ago • Promoted
    Program Manager

    Program Manager

    Leonardo DRS • Frederick, MD, United States
    Full-time
    The Leonardo DRS Airborne and Intelligence Systems business is a global leader and strategic partner committed to delivering world-class, full life-cycle defense and intelligence products that prot...Show more
    Last updated: 28 days ago • Promoted
    Consultant, Payment Intelligence

    Consultant, Payment Intelligence

    AArete • Vienna, VA, United States
    Full-time
    AArete is one-of-a-kind when it comes to consulting firm culture.We're a global, innovative management and technology consulting firm, with offices in the U. Our name comes from the Greek word for e...Show more
    Last updated: 30+ days ago • Promoted
    Remote AI Content Reviewer

    Remote AI Content Reviewer

    Outlier • Germantown, MD, United States
    Remote
    Full-time
    Earn up to $15 / hour + performance bonuses.Outlier, a platform owned and operated by Scale AI, is looking for.If you're passionate about improving models and excited by the future of AI, this is you...Show more
    Last updated: 8 days ago • Promoted
    Solution Specialist, Payment Intelligence

    Solution Specialist, Payment Intelligence

    AArete • Vienna, VA, United States
    Full-time
    AArete is one-of-a-kind when it comes to consulting firm culture.We're a global, innovative management and technology consulting firm, with offices in the U. Our name comes from the Greek word for e...Show more
    Last updated: 14 days ago • Promoted
    Manager, Payment Intelligence

    Manager, Payment Intelligence

    AArete • Vienna, VA, United States
    Full-time
    AArete is one-of-a-kind when it comes to consulting firm culture.We're a global, innovative management and technology consulting firm, with offices in the U. Our name comes from the Greek word for e...Show more
    Last updated: 30+ days ago • Promoted
    Make money your way. Deliver with Uber!

    Make money your way. Deliver with Uber!

    Uber eats • Lovettsville, DC, US
    Full-time +1
    Delivering with Uber is an alternative to a part-time or full-time job and can get you earning cash quickly.Delivering with Uber allows you to earn quick cash while maintaining the flexibility your...Show more
    Last updated: 1 day ago • Promoted
    Senior Consultant, Payment Intelligence

    Senior Consultant, Payment Intelligence

    AArete • Vienna, VA, United States
    Full-time
    We're a global, innovative management and technology consulting firm, with offices in the U.Our name comes from the Greek word for excellence : ". And excellence is exactly what we strive for.Our suc...Show more
    Last updated: 30+ days ago • Promoted
    Customer Service Manager

    Customer Service Manager

    Goodwill Monocacy Valley • Middletown, MD, US
    Full-time
    East Main Street Middletown Maryland, 21769, +1 (240) 6518994.Responsible for the oversight, leadership and achievement for the sales floor and obtaining set sales goals for Goodwill of Central and...Show more
    Last updated: 30+ days ago • Promoted
    C&I Credit Portfolio Manager IV - Annapolis or Columbia, Maryland

    C&I Credit Portfolio Manager IV - Annapolis or Columbia, Maryland

    Atlantic Union Bank • Columbia, MD, United States
    Full-time
    Responsible for providing an independent perspective in underwriting and managing complex Wholesale Banking loans and relationships up to the bank's legal lending limit. Partners with Relationship M...Show more
    Last updated: 3 days ago • Promoted
    Senior Manager - Global Payment Network Information Security Office (ISO) Consultant

    Senior Manager - Global Payment Network Information Security Office (ISO) Consultant

    Capital One • McLean, VA, US
    Full-time +1
    Senior Manager - Global Payment Network Information Security Office (ISO) Consultant.At Capital One, you will help consult on initiatives, programs, and projects to raise their game in Information ...Show more
    Last updated: 30+ days ago • Promoted
    Loan Operations Associate I (Collateral Management) (Hybrid / Columbia, MD)

    Loan Operations Associate I (Collateral Management) (Hybrid / Columbia, MD)

    Atlantic Union Bank • Columbia, MD, United States
    Full-time
    This position requires a basic understanding of loan products and foundational loan industry experience.The Loan Operations Associate I supports our customers' loan servicing needs and contributes ...Show more
    Last updated: 11 hours ago • Promoted • New!
    Senior Solution Specialist, Payment Intelligence

    Senior Solution Specialist, Payment Intelligence

    AArete • Vienna, VA, United States
    Full-time
    AArete is one-of-a-kind when it comes to consulting firm culture.We're a global, innovative management and technology consulting firm, with offices in the U. Our name comes from the Greek word for e...Show more
    Last updated: 14 days ago • Promoted
    Manager Information Technology (On-site)

    Manager Information Technology (On-site)

    Leonardo DRS • Germantown, MD, United States
    Full-time
    DRS RADA Technologies, a subsidiary of Leonardo DRS, is focused on proprietary radar solutions and legacy avionics systems supporting the defense industry globally. The company is a global pioneer o...Show more
    Last updated: 28 days ago • Promoted
    Policy and Premium Specialist 1

    Policy and Premium Specialist 1

    Legal & General America • Frederick, MD, United States
    Permanent
    Policy and Premium Specialist 1.At Legal & General America, we aim to make a positive difference in the lives of our customers, partners, colleagues, and the communities in which they live.As a rec...Show more
    Last updated: 14 days ago • Promoted
    C&I Relationship Manager IV (Hybrid Central, VA)

    C&I Relationship Manager IV (Hybrid Central, VA)

    Atlantic Union Bank • Leesburg, VA, United States
    Full-time
    The C&I Relationship Manager IV assumes the overall responsibility, development and management of their borrowing and non-borrowing portfolio. The Relationship Manager is responsible for marketing a...Show more
    Last updated: 30+ days ago • Promoted