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 Guidehouse
$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$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)....PolicyClaimsFull timeContract workFlexible hours$145k - $165k
...Position Overview The Compliance Manager is a... ..., including healthcare compliance, anti-corruption... ...development of policies, procedures, and... ...technology, we now lead 23 diverse affiliate... ...-Kickback, False Claims Act, HIPAA, Anti-... ...g., the Physician Payments Sunshine Act)....PolicyClaimsRemote workFlexible hours$222.4k - $333.6k
...global leader in healthcare technology with a... ...security, privacy, compliance, and risk management... ...initiatives.Lead the development and... ...legal frameworks, policies, standards, governance... ...will never ask for payment or sensitive... ...suspicious message claiming to be from Medtronic...PolicyClaimsFull timeH1bWork at officeLocal areaImmediate startFlexible hours$144k - $216k
...global leader in healthcare technology with a... ...Global Trade Legal & Compliance team in the Global... ...& Compliance will lead the development,... ...oversee enterprise policies, procedures, training... ...never ask for payment or sensitive personal... ...message claiming to be from Medtronic...PolicyClaimsFull timeH1bWork at officeLocal areaImmediate startWorldwideFlexible hours$65k - $88.6k
...Responsibilities Analyze healthcare payment methodologies,... ...established guidelines, policies, and procedures while... ...integrity, and compliance with applicable policies... ...stakeholders. Review claims, provider billing... ...Inc. (NYSE: HUM) is a leading U.S. healthcare company...PolicyClaimsFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- ...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
$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$72.7k - $116.6k
...SUMMARY Seeking a Quality Lead with strong data-testing leadership and healthcare domain expertise who... ...expertise: Understand claims, membership, provider,... ...to do this job. Compliance Requirement : This job... ...business conduct and company policies. As a component of...PolicyClaimsFull timeFor contractorsLocal areaRemote work$77.78k - $105.23k
...Ancillary Health Skills: Claims Data,Data Analysis,Microsoft Excel,Policy Analysis,Strategic... ...is hiring a Healthcare Coding Expert to... ...the data and create leads and referrals for... ...completeness and compliance with insurance policies... ..., audits, pre-payment and post-payment...PolicyClaimsTemporary workWork experience placementWork at officeImmediate startWorldwideFlexible hours- ...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
$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- ...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
- ...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
- Title:Lead Accountant, SEC Reporting & Technical AccountingThe... ...reporting and public company compliance requirements. This position is... ...titles or levels, per internal policy or contractual designation.... ...incentives, or discretionary payments for exceptional performance.Benefits...PolicyFull timeTemporary workLocal areaRelocation packageFlexible hours
- Title:Lead eDiscovery AnalystKBR is seeking a highly skilled and... ..., Information Security, Compliance, Human Resources, and external... ...titles or levels, per internal policy or contractual designation. Additional... ...incentives, or discretionary payments for exceptional performance....PolicyFull timeTemporary workLocal areaRemote workRelocation packageFlexible hours
$112k - $149k
...this role as a Deployment Lead on the Counter... ...often attempt to extract payment or sensitive personal information... ...or fraudulent outreach claiming to be from Anduril,... ...candidate data privacy policy, please visit . By... ...provider helps to ensure compliance with applicable laws and...PolicyClaimsFull timeWork experience placementImmediate startWorldwide$27.45 - $31.57 per hour
...passionate about accuracy, compliance, and improving patient... ..., and timely claim submission while partnering... ...in a collaborative healthcare environment and enjoy... ...HIPAA, organizational policies, and regulatory requirements... ...’s an opportunity to lead, influence processes,...PolicyClaimsHourly payFull timeWork at office- ...also serving as Navy Federal’s lead subject matter expert for... ...performance management, employment policies, compliance, contingent workforce issues... ..., including employment claims, charges, agency proceedings... ...never ask candidates for payment, bank details or personal financial...PolicyClaimsFull timeInternshipMonday to Friday
- ...maximum value and impact. Lead the Way is our... ...Clinical reviewer for policy & procedures of medical... ...quality improvement, and claims management to determine... ...annually required compliance courses, and HRSA annually... ...: Experience in healthcare administration Eligibility...PolicyClaimsContract workFor subcontractorLive inLocal area
$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$83.6k - $114.95k
...we improve lives by helping healthcare professionals do their best work... ...—learn more in our Privacy Policy: Job Description: Classification... ...Driving improved regulatory compliance and business effectiveness... ...schemes that falsely claim to represent Solventum and seek...PolicyClaimsH1bLocal areaRemote workRelocation packageFlexible hours3 days per week$151k - $314k
...Inc.Viatris is a global healthcare company uniquely... ...regulations, company policies, and industry standards... ...local policies, SOPs, and compliance frameworks aligned with... ...Drug Administration; lead submissions, risk mitigation... ...evidence supporting claims.* Build a best-in-...PolicyClaimsFixed term contractWork at officeLocal areaWorldwide3 days per week$98k - $163k
...Consultants with foundational experience in healthcare claims data, including exposure to validating,... ...and audits aimed at reducing improper payments, identifying potential fraud, and uncovering patterns that inform payment policy and cost-saving strategies.Demonstrate...PolicyClaimsFull timeWork at officeLocal areaRemote workFlexible hours2 days per week3 days per week$112k - $149k
...looking for an exceptional Lead Accountant, M&A... ...of people, processes, policies, and technology recommendations... ...attempt to extract payment or sensitive personal... ...fraudulent outreach claiming to be from Anduril,... ...provider helps to ensure compliance with applicable laws...PolicyClaimsFull timeWork experience placementImmediate start$253k - $336k
...JOBAnduril is seeking a Lead Scientist / Engineer to... ...attempt to extract payment or sensitive personal information... ...or fraudulent outreach claiming to be from Anduril,... ...candidate data privacy policy, please visit . By... ...provider helps to ensure compliance with applicable laws and...PolicyClaimsFull timeWork experience placementImmediate startRemote work- ...employment legal strategies, policies, and practices that will position... ...management, wage and hour compliance, workplace policies, and... ...regulations.Employment Litigation & Claims Management: Manage employment... ...incentives, or discretionary payments for exceptional performance....PolicyClaimsFull timeTemporary workFor contractorsLocal areaRemote workRelocation packageFlexible hours
$138.9k - $191k
...legal expertise to drive healthcare strategy. Humana is... ...kickback statute and False Claims Act; Drafting... ...order to ensure full compliance with applicable laws and... ...Inc. (NYSE: HUM) is a leading U.S. healthcare company... ...Employer It is the policy of Humana not to...PolicyClaimsFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$85k
...Healthcare Legal Solutions Attorney Position Healthcare Legal Solutions... ...to settle a high volume of claims using creative, innovative,... ...denied) medical claims for payment with governmental and corporate... ...guidelines and internal compliance protocols. Required Qualifications...ClaimsFull timeContract workWork at officeFlexible hours- ...Lucent Health combines top-tier claims management with a... ...to make smarter, cost-saving healthcare decisions. Continuous data analytics... ...and decisions respect company policies and values Accountability:... ...renewal and contract process that leads to a successful...PolicyClaimsContract work
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