Data Mining & Payment Integrity Specialist

MedReview; New York (NY); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Medical Insurance

401(k)

Paid Time Off

Flexible Spending Accounts

Life and Disability Insurance

Employee Assistance Program

Job summary

MedReview seeks a Data Mining Ideation Specialist to develop data mining audit concepts enhancing payment accuracy across Medicaid, Medicare, and Commercial lines. You will leverage CPT/HCPCS/ICD-10 coding expertise and regulatory knowledge to identify improper payments and support audits and training.

The role collaborates with audit, analytics, and operations teams to implement new payment integrity opportunities and maintain high-quality audit deliverables.

Qualifications

• Minimum five years in complex claims processing, auditing, coding, or payment integrity.
• Strong knowledge of Medicare, Medicaid, and Commercial reimbursement methodologies.
• Mastery of CPT/HCPCS/ICD coding standards with current certification.
• Experience translating policies into audit concepts and training materials.

Responsibilities

• Identify new data mining audit opportunities from regulations and client contracts.
• Define data selection criteria and audit logic for accurate claim ID.
• Validate audit outputs for consistency and payment accuracy.
• Develop concept-specific training materials for audit staff.
• Collaborate with analytics, operations, and client services teams.

Skills

Data mining

Medical coding

Claims auditing

Python

Education

CPC

COC

CCS

RHIT

Tools

Excel

3M

WebStrat

Encoder

SQL

Job description

MedReview seeks a Data Mining Ideation Specialist to develop data mining audit concepts enhancing payment accuracy across Medicaid, Medicare, and Commercial lines. You will leverage CPT/HCPCS/ICD-10 coding expertise and regulatory knowledge to identify improper payments and support audits and training.

The role collaborates with audit, analytics, and operations teams to implement new payment integrity opportunities and maintain high-quality audit deliverables.