Healthcare Revenue Integrity Analyst - Senior Consultant

at Guidehouse in Boise, Idaho, United States

Job Description


Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit


Sr. Consultants will provide client management, solution implementation and generation of project results. Senior Consultants will own project workstreams and interact w/ the client daily to ensure engagement success as well as, repare and communicate well-organized effective reports and presentations to client and internal executives. Senior Consultants are encouraged to lead, coach and mentor consultants and ensure quality deliverables. Below are additona responsabilites of the Senior Consultant.

+ Develops appropriate analytics queries using SQL to identify trends, issues, and risks with respect to inpatient, outpatient, and professional medical claims

+ Establishes and implements appropriate internal controls to achieve complete and accurate documentation & billing processes; collaborates and helps to optimize clinical documentation through analysis and prioritized evaluation

+ Responsible for financial, statistical and operational projects; present detailed analysis of medical claims and related outcomes/trends;

+ Performs ad hoc consultative research and coordination on current issues; identifies a framework of continuous improvement to accomplish programmatic goals; facilitates meetings both internal and external; works collaboratively with client resources

+ Responsible for monitoring and reporting of claims issues

+ Identify, research and document a broad variety of medical claims coding/clinical and reimbursement topics

+ Construct research papers around these topics and create presentations to explain research topics to peers within and outside of the department

+ Create effective software application requirements that encompass a multitude of coding/clinical research topics

+ Utilize claims data mining tools to aid in creating software application requirements including interpreting claims data and applying various aggregations of data to modify or test design of software application requirements

+ Develop/recognize new ways to look at data and give instructions to analysts and developers on how to query data



+ Bachelor’s degree + 5 years of experience. Client-facing experience in an analyst role is required.

+ Exhibit an understanding of relationships between database tables, methods of aggregating data

+ Able to converse with developers on database structure and programs such as Microsoft Access or SQL

+ Familiarity with medical coding sources such as CPT Assistant, medical association publications supporting medical coding and clinical research websites is expected

+ Extensive knowledge of claims data and associated industry-standard codes such as CPT, ICD diagnosis, revenue, bill type and admit/discharge status codes

+ Must be extremely detail-oriented

+ Possess strong writing and verbal communication and be able to translate difficult clinical concepts into easier-to-understand language for non-clinical readers


+ 4+ years of experience with corporate or public sector strategy development and implementation and/or operational transformations

+ 2+ years of experience with conducting organizational assessments, developing strategic outlooks/visions/plans, developing business cases, and making recommendations for improvement

+ 1+ years of experience with supporting large client organizations in either the federal or private sector

+ Experience with delivering high-quality client service in a fast-paced, unpredictable environment

+ Ability to use data to inform strategy, problem-solve and make decisions

+ Innovative mindset and intellectual curiosity regarding industry and academic trends

+ Experience in public health and/or healthcare

Additional Requirements

The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

The salary range for this role is $80,000- $120,000, and may vary based on experience and location.


About Guidehouse Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, 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 . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. 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. Rewards and Benefits 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

+ Tuition Reimbursement, Personal Development & Learning Opportunities

+ Skills Development & Certifications

+ Employee Referral Program

+ Corporate Sponsored Events & Community Outreach

+ Emergency Back-Up Childcare Program

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Job Posting: JC223236272

Posted On: Sep 09, 2022

Updated On: Dec 09, 2022

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