Senior Consultant, Payment Integrity
Core
Internal Subject Matter Expert and trusted advisor for payment integrity strategy, claims accuracy, and policy, bridging clinical, operational, and data domains to solve high-stakes healthcare problems.
Role type
Senior individual-contributor payment integrity consultant
Builds
Payment integrity strategies, policies, roadmaps, and working claim-edit rules, review agents, and validation logic for payer clients
Domain
Healthcare / Payment Integrity / Regulatory Compliance
Deliverable
client delivery
Required skills
Payment integrity policy design, claims auditing judgment, regulatory compliance analysis, executive stakeholder management, market trend investigation, contract review, fraud/waste/abuse mitigation, client engagement leadership, technical configuration of claim-edit logic
Preferred skills
Six Sigma Black Belt, CPC, CCS, CFE, RHIA, RHIT, Agile/lean product development, AI/agent-based automation tools
Technologies
Snowflake, Databricks
Responsibilities
Lead client discovery sessions, workshops, and presentations; Serve as internal SME and trusted advisor for sponsors and risk panels; Investigate market, industry, and regulatory trends; Research contracts and design tailored payment integrity strategies; Create and maintain payment integrity policy; Configure and validate Payment Integrity accelerators against client policies and data
Seniority
Senior, hands-on IC
