Healthcare Claims Payment Policy Managing Consultant

About the role

Policy work sits across clinical, finance, legal and analytics groups, turning research and claims data into guidance that adjudicators can actually use. Success looks like policies that are clear, current and applied the same way every time.

At a glance

What you will do

• Run the payment policy workstream: set priorities, manage the portfolio, align stakeholders and push decisions through on time
• Write and keep up payment policies, reimbursement guidance, FAQs, briefings and rollout materials
• Turn policy and coding rules into claims edits, bundles, business requirements, fee schedules and payment controls
• Coordinate readiness, communications, testing and issue resolution so new policies are adopted consistently

What they look for

• Five or more years in payment or reimbursement policy, payment integrity, claims, revenue cycle or fee schedule work
• Track record drafting, standardising and maintaining payment policies and provider billing guidance
• Knowledge of Medicare, Medicaid, TRICARE and commercial reimbursement, plus CPT, HCPCS, ICD, revenue codes, DRGs, modifiers and bundled paym
• Can turn policy questions into data requests and explain payment impact to technical and non-technical audiences

Nice to have

• Experience in a large federal health, payer or provider setting with complex reimbursement rules and many stakeholders