Consultant, Payment Solutions

Consultant, Payment Solutions At AArete, we pride ourselves on having a unique and enriching consulting firm culture. We are a global management and technology consulting firm dedicated to excellence, with offices in the U.S., India, and the U.K. Our commitment to our people is unmatched, offering robust career development and competitive life and wellness benefits. AArete's "Culture of Care" reflects our holistic approach to enhancing the employee experience. We encourage our team members, affectionately known as AAretians, to reach their full potential while contributing meaningfully to our mission, fostering personal development and job satisfaction. The Role In the fast-paced world of health plans, timely and accurate claims reimbursement remains a significant challenge. Our Payment Solutions team goes beyond conventional payment integrity, focusing on accurately identifying and rectifying erroneous payments while preventing future issues. As a Consultant in this space, you'll address payment policies, provider contracts, and member eligibility, ensuring efficient operations. In this role, you will be instrumental in delivering exceptional client service while reporting to the Payment Solutions Manager. You'll serve as a subject matter expert, leveraging your skills in claims analytics, process improvements, automation integration, and configuration setups. Work You'll Do Identify and analyze opportunities for improving claims payment accuracy in collaboration with client teams. Utilize analytics and your knowledge of payment methodologies, such as IPPS/OPPS, to discover claims payment opportunities. Support clients in enhancing processes and integrating automation initiatives. Conduct research on regulatory changes and market trends affecting health plan reimbursements. Prepare clear and actionable client deliverables. Communicate effectively, exercising sound judgment in your work. Perform other duties as assigned. Requirements 2+ years of experience in consulting, provider revenue cycle, payment integrity, or payer organizations. Foundational knowledge of claims processing across multiple business lines, including Medicare, Medicaid, and Commercial. Experience in various spend areas, including outpatient, inpatient, and ancillary services. Skill in identifying and analyzing mispaid claims for accuracy and compliance. Knowledge of industry tools related to claims processing and management. Understanding of end-to-end claims processes, including provider lifecycle and network optimization. Strong professional communication skills, both written and verbal. Experience in coaching and mentoring team members. Advanced proficiency in Microsoft Excel and basic/intermediate SQL for data analysis. Strong analytical and problem-solving abilities. Ability to identify client savings opportunities and develop actionable business cases. Bachelor's degree or equivalent required. Direct client interaction with potential travel to client sites. Authorization to work in the United States without the need for employer sponsorship. Preferred Requirements Policy & Claims Editing Expertise: Researching and interpreting relevant healthcare policies and regulations. Experience in writing reimbursement policies and claims editing. Proficiency in data mining to identify errors. Ability to compare edits and policies effectively. Familiarity with claims editing processes, including Fraud Detection and Medical Record Reviews. Contract Configuration & Provider Data Expertise: Understanding provider contract terms, tariffs, and pricing methodologies. Knowledge of contract carve-outs, bundled services, and readmission policies. Experience in contract pricing and claims reimbursement analysis. Understanding of provider TIN and NPI relationships. Familiarity with provider lifecycle management and network processes. Experience with claims adjudication systems (e.g., Facets, QNXT). Willingness to work from our Chicago office as needed. Compensation & Benefits Flexible PTO, monthly refuels, volunteer time off, and 10 paid holidays. Own Your Day flexible work policy. Competitive majority employer-paid benefits including Medical, Dental, Vision, and 401K match. Generous parental leave options. Employer-paid Life and Disability Insurance. Charitable contribution matching program. Incentives for client referrals and new client commissions. Discounts for bike-sharing programs. The estimated base salary range for this position is $84,000 - $102,000, plus eligibility for an annual discretionary bonus. This salary range serves as a guideline and may vary based on factors such as experience and certifications. We are committed to a diverse workforce. AArete welcomes applications from all qualified candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Join us to help transform the future of health plan payments with excellence and insight at the center of your work. Location: Chicago, IL

Created: 2026-03-11