Healthcare Data Mining & Audit Ideation Lead

MedReview; United States; Remote; USD 90,000 - 110,000; Full time

Job summary

MedReview seeks a Data Mining Ideation Specialist to develop data mining audit concepts across Medicaid, Medicare, and Commercial lines. You will leverage coding knowledge, claims adjudication, and reimbursement methodologies to identify improper payments with high accuracy.

Collaboration with audit, analytics, and operations teams is essential to define data selection, validate results, and support ongoing quality initiatives while maintaining excellence in CPT/HCPCS/ICD-10 coding standards.

Qualifications

• Minimum five years in complex claims processing or payment integrity.
• Mastery of CPT, HCPCS, and ICD coding standards and guidelines.
• Knowledge of Medicare, Medicaid, and Commercial reimbursement methodologies.
• Current coding certification required: CPC/COC/CCS/RHIT.

Responsibilities

• Identify and develop data mining audit concepts to promote payment accuracy across Medicaid, Medicare, and Commercial lines.
• Define data selection criteria and audit logic requirements for accurate claim identification.
• Validate audit outputs to ensure integrity and payment accuracy.
• Collaborate with audit, analytics, and operations teams to develop new overpayment recovery opportunities.
• Maintain expertise in coding guidelines and reimbursement methodologies.

Skills

Medical coding knowledge

Data mining

Claims auditing

Excel proficiency

Regulatory knowledge

Education

CPC certification

COC certification

CCS certification

RHIT certification

Tools

3M

WebStrat

Encoder

Job description

MedReview seeks a Data Mining Ideation Specialist to develop data mining audit concepts across Medicaid, Medicare, and Commercial lines. You will leverage coding knowledge, claims adjudication, and reimbursement methodologies to identify improper payments with high accuracy.

Collaboration with audit, analytics, and operations teams is essential to define data selection, validate results, and support ongoing quality initiatives while maintaining excellence in CPT/HCPCS/ICD-10 coding standards.