McLean, Virginia, United States · On-site
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Washington, District of Columbia, United States · On-site
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Lewisville, Texas, United States · Remote OK
$89k–$148k/yr
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Washington, District of Columbia, United States · On-site
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Washington, District of Columbia, United States · On-site
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Arlington, Virginia, United States · On-site
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Washington, District of Columbia, United States · On-site
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Vilnius, Vilnius County, Lithuania · On-site
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San Antonio, Texas, United States · Remote OK
$106k–$176k/yr
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McLean, Virginia, United States · On-site
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San Antonio, Texas, United States · Remote OK
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San Antonio, Texas, United States · Remote OK
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McLean, Virginia, United States · On-site
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Baltimore, Maryland, United States · On-site
$74k–$124k/yr
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Huntsville, Alabama, United States · On-site
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Washington, District of Columbia, United States · On-site
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McLean, Virginia, United States • On-site
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The consultant will draft, standardize, and implement healthcare payment policies to improve accuracy and compliance within a large payer environment. They will translate complex reimbursement research and claims data into operational guidance for cross-functional stakeholders.
Candidates must have 5+ years of experience in payment or reimbursement policy and deep knowledge of healthcare billing standards and coding concepts. Strong analytical skills are required to translate policy into operational rules and assess the financial impact of reimbursement changes.
Travel Required:
Clearance Required:
We are looking for a Healthcare Claims Payment Policy expert to draft, standardize, implement, and maintain payment policies that improve payment accuracy, cost control, provider experience, and compliance in a large payer environment. In this role, you will help shape how reimbursement policies are researched, written, operationalized, and communicated across clinical, operational, finance, legal, analytics, and implementation stakeholders. You will translate reimbursement research, claims data, stakeholder input, and policy decisions into clear, operationally usable guidance that supports consistent claims adjudication and stakeholder understanding. The ideal candidate brings strong payer and provider reimbursement policy experience, including knowledge of Medicare, Medicaid, TRICARE, commercial payer policy, provider billing standards, claims coding, modifiers, fee schedules, and reimbursement impact analysis.
Support the payment policy workstream. Set priorities, manage the policy portfolio, align stakeholders, and drive timely decisions that support accurate and consistent reimbursement.
Draft and standardize payment policies. Write, update, and maintain clear payment policies, reimbursement guidance, FAQs, briefings, and implementation materials.
Translate policy into operational requirements. Convert reimbursement policy, payer guidance, coding requirements, and stakeholder decisions into claims rules, edits, bundles, business requirements, payment controls, fee schedules, and operational decision logic.
Support implementation and stakeholder adoption. Coordinate readiness, communications, testing support, reimbursement logic clarification, issue resolution, and stakeholder materials so policies are understood and applied consistently.
Monitor reimbursement policy changes. Track federal, state, and commercial payer updates, coding changes, fee schedule changes, and provider billing guidance to keep policies current.
Analyze reimbursement and claims impact. Define data needs, review claims and reimbursement data, assess payment impacts, and use findings to inform policy decisions, implementation planning, and stakeholder discussions.
5+ years in payment policy, reimbursement policy, payment integrity, claims, revenue cycle, fee schedule development, or healthcare reimbursement.
Experience drafting, standardizing, implementing, and maintaining payment policies, reimbursement guidance, provider billing guidance, and stakeholder communications.
Knowledge of Medicare, Medicaid, TRICARE, commercial payer reimbursement policy, provider billing standards, fee schedules, claims adjudication rules, and healthcare claims coding concepts including CPT, HCPCS, ICD, revenue codes, DRGs, modifiers, bundled payments, unlisted codes, non-reimbursable codes, and claims edits.
Ability to translate reimbursement policy and payer guidance into claims rules, edits, bundles, business requirements, payment controls, operational decision logic, and defensible payment integrity approaches.
Ability to translate policy questions into data requests, interpret claims and reimbursement data, and clearly explain operational and payment impact to technical and non-technical stakeholders.
Experience working in a large federal health, payer, or provider environment with complex reimbursement policies, multiple stakeholders, and cross-functional implementation partners.
Experience supporting third-party administrator or claims operations implementation, including translating policy into business requirements, clarifying reimbursement logic, supporting testing, resolving operational questions, and tracking implementation issues.
Experience conducting claims, reimbursement, cost, or payment impact analyses using Excel, Power BI, Tableau, SQL, or similar tools.
Experience leading a team or workstream, including setting priorities, assigning work, reviewing deliverables, coordinating subject matter experts, tracking deadlines, and communicating status, risks, and decisions to leadership.
What We Offer:
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.
Benefits include:
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
Student Loan PayDown
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program
Mobility Stipend
Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities 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.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.
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.
Empowering our clients to meaningfully shape the future.
Guidehouse is a global AI-led professional services firm delivering advisory, technology, and managed services to the commercial and government sectors. With an integrated business technology approach, Guidehouse drives efficiency and resilience in the healthcare, financial services, energy, infrastructure, and national security markets. Built to help clients across industries outwit complexity, the firm brings together approximately 18,000 professionals to achieve lasting impact and shape a meaningful future.
Offices: 1676 International Dr, 800, McLean, Virginia 22102, US · 1800 Tysons Blvd, McLean, Virginia 22102, US · 1000 Wilson Blvd, Suite 1400, Arlington, Virginia 22209, US · 111 Congress Ave, Suite 2500, Austin, Texas 78701, US · 125 High St, Suite 401, Boston, Massachusetts 02110, US
Empowering our clients to meaningfully shape the future.
Guidehouse is a global AI-led professional services firm delivering advisory, technology, and managed services to the commercial and government sectors. With an integrated business technology approach, Guidehouse drives efficiency and resilience in the healthcare, financial services, energy, infrastructure, and national security markets. Built to help clients across industries outwit complexity, the firm brings together approximately 18,000 professionals to achieve lasting impact and shape a meaningful future.
Offices: 1676 International Dr, 800, McLean, Virginia 22102, US · 1800 Tysons Blvd, McLean, Virginia 22102, US · 1000 Wilson Blvd, Suite 1400, Arlington, Virginia 22209, US · 111 Congress Ave, Suite 2500, Austin, Texas 78701, US · 125 High St, Suite 401, Boston, Massachusetts 02110, US
