Remote Data Mining Lead – Healthcare Payment Integrity

MedReview

United States

Remote

USD 85,000 - 90,000

Full time

6 days ago

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Job summary

MedReview is seeking a Data Mining Senior Auditor to join our Payment Integrity team. This role focuses on identifying cost-savings through advanced data mining, claims analysis, and innovative audit concepts.

You will leverage expertise in healthcare claims processing and reimbursement to drive measurable client savings and operational improvements. Ideal candidates have strong analytical skills, a deep understanding of coding and reimbursement methods, and the ability to transform complex data

Qualifications

Minimum high school diploma or GED is not sufficient for this senior role.
Seven or more years of healthcare claims investigation, payment integrity, or data mining experience.
Five or more years of leadership experience within healthcare auditing, payment integrity, or related functions.
Advanced proficiency with Microsoft Excel and SQL Server, Power BI skills are valued.

Responsibilities

Develop, implement, and maintain data mining strategies to identify overpayments and savings opportunities.
Create and deploy edits, algorithms, and auditing methodologies to flag suspect claims.
Perform detailed claims analyses to identify trends and opportunities for enhanced savings.
Collaborate with cross-functional teams to support pilot programs and client outcomes.
Build and maintain dashboards, reports, and performance metrics for Payment Integrity.