Data Mining Consultant (Client Lead)

View Moreicons; United States; Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Data Mining Consultant to lead a dedicated team in enhancing payment integrity processes. This client-facing role involves analyzing payment-related data, ideating audits, and ensuring compliance while fostering a collaborative environment. With a focus on innovative solutions, you will develop and manage a team to meet client targets and drive operational efficiency. Join a forward-thinking company offering competitive benefits and a supportive work culture, where your expertise will make a significant impact on client success.

Benefits

Medical

Dental

Vision

Life Insurance

Short-Term and Long-Term Disability

Flexible Spending Account

Life Assistance Program

401K with employer contribution

PTO and Sick Time

Tuition Reimbursement

Qualifications

• Strong knowledge of claim processing and reimbursement.
• Experience in developing auditing rules and paradigms.

Responsibilities

• Lead a team in identifying audit opportunities and discrepancies.
• Manage data collection and analytics for payment integrity.

Skills

Data Mining Techniques

Claims Processing

Fraud Prevention

Data Analytics

Management Experience

Communication Skills

Microsoft Office

Education

5+ years in Claims Processing

Management Experience

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

Job description

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title:

Data Mining Consultant (Client Lead)

Job Description:

We are currently hiring a talented Consultant II, Lead Consultant Data Supervisor. This is a client-facing role responsible for leading a team of experienced professionals in identifying new audit opportunities, researching pricing methodologies, and engaging with various work teams to generate system automation and enhancement capabilities in our state-of-the-art audit workstation. In this role, you will develop, train, and manage a team of dedicated professionals to ensure client targets and KRAs are met, while also acting as an individual contributor in these areas.

Key Requirements:

• Review and analyze payment-related data using data mining techniques to ensure accuracy, compliance, and fraud prevention in financial transactions.
• Lead team members to meet targets.
• Ideate and perform audits on payment data, identifying discrepancies, errors, and fraudulent activities, and providing recommendations for process improvement.
• Manage supervision, training, and development of your team, as well as data collection, data analytics, and data reporting for data mining programs, including but not limited to COB, duplicate, contractual, billing errors, and overlapping services.
• Participate in client meetings and lead pertinent discussions.
• Communicate client claim payment practices and ensure information is shared with their team.

Education, Experience, and Skills:

• 5+ years of knowledge of direct claim processing/reimbursement, medical facility contracts, fee schedules, inpatient/outpatient/physician claims required.
• 3 or more years of management experience in claims processing is a strong plus.
• Experience ideating and developing new auditing rules and paradigms.
• Experience in business case analysis and helping design BRD, pricing, COB, platform analytics.
• Experience validating rules through testing methodologies, auditing, payment processing, or financial fraud prevention is a must.
• Ability to load and synthesize healthcare data from multiple sources.
• Experience working within a health plan, managed care organization, provider-operated healthcare environment, or third-party administrator.
• Development of end-to-end payment integrity reports such as Data Intake, Audit Selections, Findings, Appeals, Medical Record Management, Audit Operations, Recovery Operations, Provider Correspondence, and Forecasting & Invoicing.
• Maintaining a working knowledge of CMS transmittals, RAC, and OIG reports is a must.
• Prior claims auditing or consulting experience desirable in either a provider or payer environment.
• Provide recommendations for improving payment integrity processes, fraud prevention measures, and operational efficiency based on audit findings.
• Work with audit teams and establish processes to ensure deployed concepts are working as expected, leading to higher findings and hit rates.
• Excellent communication skills, both oral and written.
• Strong interpersonal skills to support collaborative teamwork.
• Proficient in Microsoft Office: Word and Excel; Access highly preferred.
• Ability to interpret and assess complex payment datasets.

Sagility Offers Competitive Benefits Including:

• Medical
• Dental
• Vision
• Life Insurance
• Short-Term and Long-Term Disability
• Flexible Spending Account
• Life Assistance Program
• 401K with employer contribution
• PTO and Sick Time
• Tuition Reimbursement

Join our team, we look forward to talking with you!

An Equal Opportunity Employer/Vet/Disability

Location:

Work@Home USA, United States of America