Guidehouse Revenue Integrity Analyst - Senior Consultant in Boston, Massachusetts
Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.
Sr. Consultants will provide client management, solution implementation and generation of project results. Senior Consultants will own project workstreams and interact w/ the client daily to ensure engagement success as well as, repare and communicate well-organized effective reports and presentations to client and internal executives. Senior Consultants are encouraged to lead, coach and mentor consultants and ensure quality deliverables. Below are additona responsabilites of the Senior Consultant.
Develops appropriate analytics queries using SQL to identify trends, issues, and risks with respect to inpatient, outpatient, and professional medical claims
Establishes and implements appropriate internal controls to achieve complete and accurate documentation & billing processes; collaborates and helps to optimize clinical documentation through analysis and prioritized evaluation
Responsible for financial, statistical and operational projects; present detailed analysis of medical claims and related outcomes/trends;
Performs ad hoc consultative research and coordination on current issues; identifies a framework of continuous improvement to accomplish programmatic goals; facilitates meetings both internal and external; works collaboratively with client resources
Responsible for monitoring and reporting of claims issues
Identify, research and document a broad variety of medical claims coding/clinical and reimbursement topics
Construct research papers around these topics and create presentations to explain research topics to peers within and outside of the department
Create effective software application requirements that encompass a multitude of coding/clinical research topics
Utilize claims data mining tools to aid in creating software application requirements including interpreting claims data and applying various aggregations of data to modify or test design of software application requirements
Develop/recognize new ways to look at data and give instructions to analysts and developers on how to query data
Bachelor’s degree + 5 years of experience. Client-facing experience in an analyst role is required.
Exhibit an understanding of relationships between database tables, methods of aggregating data
Able to converse with developers on database structure and programs such as Microsoft Access or SQL
Familiarity with medical coding sources such as CPT Assistant, medical association publications supporting medical coding and clinical research websites is expected
Extensive knowledge of claims data and associated industry-standard codes such as CPT, ICD diagnosis, revenue, bill type and admit/discharge status codes
Must be extremely detail-oriented
Possess strong writing and verbal communication and be able to translate difficult clinical concepts into easier-to-understand language for non-clinical readers
4+ years of experience with corporate or public sector strategy development and implementation and/or operational transformations
2+ years of experience with conducting organizational assessments, developing strategic outlooks/visions/plans, developing business cases, and making recommendations for improvement
1+ years of experience with supporting large client organizations in either the federal or private sector
Experience with delivering high-quality client service in a fast-paced, unpredictable environment
Ability to use data to inform strategy, problem-solve and make decisions
Innovative mindset and intellectual curiosity regarding industry and academic trends
Experience in public health and/or healthcare
The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
This role is available to candidates in the PST, CST and EST time zones.
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.
Rewards and Benefits
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.
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
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program
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