Healthcare Claims Policy Lead Payment & Compliance
Guidehouse
Guidehouse is seeking a Healthcare Claims Payment Policy expert to draft, standardize, implement, and maintain payment policies in a large payer environment. You will shape reimbursement policy, translate research and data into operational guidance, and collaborate across clinical, operational, finance, legal, analytics, and implementation teams. The ideal candidate brings 5+ years in payment policy and knowledge of Medicare, Medicaid, TRICARE, and payer policy, with the ability to convert #J-18808-Ljbffr
$113k - $188k
...Public Trust We are looking for a Healthcare Claims Payment Policy expert to draft, standardize, implement... ...control, provider experience, and compliance in a large payer environment. In this... ...SQL, or similar tools. Experience leading a team or workstream, including setting...PolicyClaimsTemporary workLocal areaFlexible hours$149.8k - $171k
...Manager, Counsel - Network Contracting Team Lead (Global Payment Network) The Capital One Legal... ...support from an employer). Hybrid Work Policy This role is designated as a hybrid position... ...) committed to non-discrimination in compliance with applicable federal, state, and...PolicyFull timeContract workPart timeH1bWork at officeLocal area- ...Contribute to complex healthcare consulting... ...audits, disputes, claims analysis, investigations, compliance reviews, and litigation... ...reimbursement data, policies, and contracts for... ...processing practices, and payment determinations.... ...and help employees lead fulfilling lives. Learn...PolicyClaimsContract workFlexible hours
$176.9k - $239.34k
...is responsible for leading a regional team of... ..., reimbursement policy, competitive landscape... .... Ensure team compliance with established... ...degree in business, healthcare, or a related... ...coding, billing, claims, benefit design, and... ...coding, coverage, and payment methodologies....PolicyClaimsFull timeWork at officeLocal areaRemote workWork from homeFlexible hours$120.23k - $158.61k
Summary You will serve as a Lead Management Analyst in the International... ...workforce management policy on the full spectrum of human... ...quantity of work, regulatory compliance and effectiveness of service to... ...eligibility and qualification claims made in your resume. Applicants...PolicyClaimsPermanent employmentFull timePart timeInterim roleSecond jobWork at officeLocal areaImmediate startRemote workRelocationRelocation package- ...attorney will be responsible for leading and managing all aspects of... ...negotiations through final claim resolution and program closure... ..., reporting obligations and compliance issues, and settlement fund governance... ...principle and as a matter of policy. We will recruit, hire, train...PolicyClaimsPermanent employmentContract workTemporary workWork at officeLocal area
$210k - $240k
...As a leading provider of outcomes-driven care... ...personal healthcare coverage : Medical... ...Medical Advisory, Compliance, Account Management... ...internal contracting policies, playbooks, and templates... ...-Kickback, False Claims Act, corporate... ...medical homes, bundled payment programs). Broad...PolicyClaimsContract workFlexible hours$72.7k
...SUMMARY Seeking a Quality Lead with strong data-testing leadership and healthcare domain expertise who... ...expertise: Understand claims, membership, provider,... ...employees to do this job. Compliance Requirement : This job... ...business conduct and company policies. As a component of job...PolicyClaimsFor contractorsLocal areaRemote work$150k - $400k
...with deep roots in the healthcare industry, the firm has... ..., transactional, and compliance matters in the market.... ...experience handling False Claims Act (FCA)... ...RADV audits, Medicare payment disputes, or other healthcare... ...categories. It is Jobot’s policy to comply with all...PolicyClaimsWork at officeLocal areaFlexible hours$62k - $69k
...within established College policies and under the... ...readiness, revenue integrity, compliance, and service standards... ..., insurance benefits, payment expectations, and... ...readiness, charge capture, claims-related issues, and... ...of dental or healthcare practice operations and...PolicyClaimsContract workWork at office- ...Guidehouse Inc. is seeking a Healthcare Claims Payment Policy expert to draft, standardize, implement, and maintain payment policies within a large payer environment. You will translate reimbursement research and policy decisions into operational guidance that supports...PolicyClaims
$149k - $248k
...as the Palantir Foundry technical lead for a major federal health payment integrity modernization... ...operating environment that connects healthcare claims, payments, referrals, authorizations... ...access control, auditability, and compliance requirements.Experience n Python,...ClaimsFlexible hours- ...Arlington, VA is seeking a strategic Communications Manager to own US Payments messaging and drive national campaigns that showcase fintech... ...Payments, manage media relations, and coordinate with product, policy, and global teams to deliver impactful campaigns and...Policy
- ...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...PolicyClaims
- ...Services LLC seeks a strategic communications leader to own the U.S. Payments narrative, shaping how the payments business communicates with... ...and cross-functional collaboration, you will align product and policy, coordinate with events, and ensure consistent messaging across...Policy
- ...recently been selected to lead efforts in Washington... ...(CCBHC), reflecting compliance with stringent national... ...eligibility, enrollment, and claims; coordinating the... ...regulations, and company policies while maintaining accurate... ...resolution and payment of benefits.• Maintain...PolicyClaimsHourly payLocal areaRelocation package
- ...services company with leading capabilities in digital... ...operations, improve healthcare experiences, and responsibly... ...healthcare platforms, claims systems, care... ...transparency, privacy, security, compliance, risk management,... ...Affirmative Action Policy StatementAccenture is...PolicyClaimsWork experience placementLive inWork at officeLocal area
$170k - $230k
...Services (AWS) is seeking a Deal Lead for the Strategic Customer... ...& Entertainment, Energy, Healthcare Life Sciences, Automotive and... ..., and local laws and Company policies. Criminal history may have a... ...package will include sign-on payments, restricted stock units (RSUs...PolicyLocal areaFlexible hours- ...qualified and experienced Healthcare Litigation Associate... ...connection with False Claims Act litigation,... ...investigations, and complex compliance issues. The ideal... ...persuasive legal writing. Lead internal... ...principle and as a matter of policy. We will recruit, hire...PolicyClaimsContract workWork at officeLocal area
$156.8k - $261.3k
...touches virtually every aspect of healthcare. We are known for delivering... ..., we want to hear from you. Lead Counsel, Securities &... ...engagement, and public company compliance. The successful candidate will... ...Board processes, governance policies, governance technology, disclosure...PolicyRemote work- ...HealthStaff is recruiting for a Senior Healthcare Regulatory Attorney in North... ...healthcare providers on billing compliance, fraud and abuse laws, and reimbursement policy under Medicare, Medicaid, and... ...Kickback Statute, Stark Law, and False Claims Act. Counsel clients on...PolicyClaimsPermanent employment
- ...program integrity and compliance, quality improvement and... ...as the relationship lead for the VA account, building... .... Track VA policy, budget, and acquisition... ...community care policy, claims modernization,... ...Deep knowledge of VA healthcare delivery, community care...PolicyClaimsContract workRemote work
$80k - $128k
...Medical Review Team Lead - Medicaid Job Locations US Requisition... ...within broadly defined policies and practices to determine the... ...versed in research on medical claims data and other sources of... ...the Government Make claim payment decisions based on clinical knowledge...PolicyClaimsContract workFor contractorsFor subcontractorWork at officeRemote workShift workNight shift$50k
...verify information. Reviews monthly claim forms and enters data for processing. Validates... ...checks or other issues related to payment processing. Prepares daily weekly and monthly reports in compliance with reporting policies and procedures and submits in a timely manner...PolicyClaimsFull timeWork at office$171k - $247k
...Senior Medical Device Regulatory Policy Lead Share Senior Medical... ...related to digital health, healthcare AI, and Software as a Medical... ...teams to align device feature claims with necessary clinical... ...have no impact on statutory payments. Current or past grants do not...PolicyClaimsTemporary work- Capital One seeks a Manager, Risk Management for the Global Payments Network to lead international regulatory operations, ensuring a scalable,... ...will centralize regulatory engagement, drive cross-border compliance, and collaborate with business, product, and technology...
$215k - $255k
.... office of FBT Gibbons is seeking a Healthcare Regulatory/Compliance Attorney. FBT Gibbons LLP is a national... ...and regulations, including the False Claims Act, Stark Law, AntiKickback Statute,... ...in-office), a “dress for your day” policy, and robust support for both professional...PolicyClaimsTemporary workWork at office- ...maximum value and impact. Lead the Way is our... ...Clinical reviewer for policy & procedures of medical... ...quality improvement, and claims management to... ...Health annually required compliance courses, and HRSA annually... ...Reviewer: Experience in healthcare administration...PolicyClaimsContract workFor subcontractorLive inLocal area
$110.9k - $183.3k
...department is seeking talented Health Policy Researchers to contribute to... ..., and costs. RAND researchers lead and contribute to projects... ...program policy, coverage, payment, or utilization Commercial... ...service or Medicare Advantage claims data State all-payer claims...PolicyClaimsWork experience placement$120k - $150k
...Evaluations with our Healthcare Innovations team. Our... ...evidence and save lives by leading rigorous research and... ...of Medicare payment and service delivery models... ...Medicare and/or Medicaid claims analyses, analysis of... ...knowledge of Medicare payment policy, Medicare Advantage,...PolicyClaimsFull timeFixed term contractH1bWork at officeLocal areaRemote work
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