Guidehouse

Healthcare

HealthcarePaymentIntegrityAssociateDirector

$149–248k United States FULL TIME Remote Friendly
Market Sentiment
HIGH DEMAND

Neural analysis suggests this role is
optimal for Director candidates.

The Brief

“Healthcare Payment Integrity Associate Director at Guidehouse. Skills: Clinical documentation, Coding, Reimbursement, Payment integrity. Lead transformation engagements. Own delivery quality”

What You'll Achieve.

Measurable improvement opportunities; Monitor value realization

Industry & Context.

Healthcare
Problems you'll solve

Root-cause analysis

Eligibility Requirements

Up to 25% travel, Ability to Obtain Public Trust clearance, US citizenship required

What They're Looking For.

Must Have

10+ years healthcare consulting, 10+ years industry leadership, Ability to obtain Public Trust clearance

Nice to Have

Master of Health Administration preferred, MBA preferred, MPH preferred, Other relevant advanced degree preferred, AAPC coding credentials, AHIMA coding credentials, Experience with healthcare technology, Experience with classification systems, Experience with clinical documentation solutions, Experience with coding solution environments, Experience with analytics-enabled transformation, Experience with AI-supported transformation, Experience across payer advisory, Experience with health information vendors, Experience with professional associations, Experience supporting reimbursement operations, Experience supporting payment operations, Knowledge of revenue cycle, Knowledge of DRG validation, Knowledge of audit/compliance, Knowledge of utilization improvement, Knowledge of quality improvement, Knowledge of risk adjustment, Knowledge of fraud, waste, and abuse, Knowledge of payment-integrity concepts, Experience designing education programs, Experience with thought leadership, Experience with market-facing content

What You'll Do.

Lead transformation engagements

Own executive communications

Own integrated storylines

Translate subject-matter depth

Advise senior stakeholders

Assess current-state workflows

Assess documentation practices

Assess coding operations

Define target-state processes

Define measurable improvement opportunities

Apply payer-provider expertise

Connect reimbursement mechanics

Connect classification systems

Connect payment policy

Connect risk adjustment

Connect incentive structures

Guide analytics-enabled transformation

Use revenue cycle data

Prioritize interventions

Monitor value realization

Design sustainable improvements

Develop executive-ready deliverables

Develop decision materials

Build high-performing teams

Mentor high-performing teams

Drive business development

Drive practice growth

Shape solution offerings

Develop reusable assets

Bring thought leadership

How You'll Work.

Team & Collaboration

Cross-functional engagements; Client stakeholders; Clinical leaders; Operational leaders; IT leaders; Compliance leaders; Finance leaders

Communication Scope

Executive communications; Executive presentations

Process & Methodology

Workplans, Staffing, Budgets

Full Job Description

**_Job Family_ :** Strategy & Transformation Consulting ** _Travel Required_ :** Up to 25% **_Clearance Required_ :** Ability to Obtain Public Trust _**What You Will Do:**_ * Lead multiple concurrent transformation engagements for federal health clients, owning delivery quality, workplans, staffing, budgets, executive communications, and integrated storylines across workstreams. * Serve as a senior SME in clinical documentation integrity, coding, revenue integrity, reimbursement, payment policy, and payment integrity, translating subject-matter depth into practical transformation roadmaps and operating model decisions. * Advise senior client stakeholders on the intersection of documentation, coding, claims/payment accuracy, quality measurement, utilization, denials, compliance, and financial performance. * Assess current-state workflows, documentation practices, coding operations, and performance drivers; identify root causes; and define target-state processes, governance, controls, and measurable improvement opportunities. * Apply payer-provider expertise to federal health environments, connecting reimbursement mechanics, classification systems, payment policy, risk adjustment, and incentive structures to operational and clinical outcomes. * Guide analytics-enabled transformation by using claims, revenue cycle, coding, and operational data to generate insights, size opportunities, prioritize interventions, and monitor value realization. * Partner with clinical, operational, IT, compliance, and finance leaders to design sustainable improvements in documentation quality, coding accuracy, audit readiness, provider education, and workflow efficiency. * Develop executive-ready deliverables, workshops, and decision materials that clearly communicate the “so what” for C-suite, program, and operational leadership. * Build and mentor high-performing teams through apprenticeship-style coaching, including upskilling staff in clinical documentation, coding, reimbursement, anal

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