Remote Data Mining Senior Auditor - Healthcare

MedReview Inc.; New York (NY); Remote; USD 85,000 - 90,000; Full time

Job summary

MedReview is seeking a Data Mining Senior Auditor to advance our Payment Integrity program. You will identify overpayments and savings opportunities through advanced data mining, claims analysis, and novel audit concepts, driving measurable client value.

This remote, senior role leads data-driven investigations, develops audits, and creates dashboards using SQL Server and Power BI, while mentoring staff and ensuring compliance with coding and reimbursement guidelines.

Qualifications

• Minimum high school diploma or GED required.
• 7+ years in healthcare claims investigation, payment integrity, or data mining.
• 5+ years of leadership within healthcare auditing or related functions.
• Expertise in healthcare claims processing and reimbursement methodologies.
• Strong analytical, critical thinking, and problem-solving skills.
• Experience developing performance measures and quality assurance methodologies.
• Strong verbal and written communication skills.
• High attention to detail and client satisfaction.
• Advanced proficiency with Microsoft Excel.
• Ability to learn SQL Server, Power BI and related analytics platforms.
• Knowledge of coding edits, reimbursement methodologies, and medical claims payment systems.
• Understanding of medical terminology, procedures, diagnoses, and claims adjudication.
• Experience applying coding guidelines and billing regulations.
• Knowledge of Medicare, Medicaid, and commercial payer reimbursement requirements.
• Experience with health plans, third-party administrators, or payment integrity organizations.
• Ability to work independently in a remote environment.

Responsibilities

• Develop, implement, and maintain data mining strategies identifying overpayments and cost-saving opportunities.
• Create and deploy payment integrity edits, algorithms, and auditing methodologies.
• Perform detailed claims analyses to identify trends and opportunities for enhanced savings.
• Assist in developing new audit concepts and payment integrity programs.
• Continuously evaluate and enhance savings strategies to improve client outcomes.
• Produce detailed data mining reports and analyses for Payment Integrity operations.
• Extract and interpret information from large healthcare claims datasets to support decisions.
• Develop and maintain operational reports, dashboards, and performance metrics.
• Utilize data analytics tools to identify meaningful business insights and opportunities.
• Collaborate with cross-functional teams and leadership to drive results.

Skills

Data mining

Healthcare claims analysis

Leadership

SQL

Power BI

Excel

Education

Bachelor’s degree in Health Information Management, Healthcare Administration, Data Analytics, Business, or a related field

CPC, CCS, CPMA, RHIA, RHIT, or other relevant coding, billing, or auditing certification

Tools

SQL Server

Power BI

Facets

QNXT

Job description

MedReview is seeking a Data Mining Senior Auditor to advance our Payment Integrity program. You will identify overpayments and savings opportunities through advanced data mining, claims analysis, and novel audit concepts, driving measurable client value.

This remote, senior role leads data-driven investigations, develops audits, and creates dashboards using SQL Server and Power BI, while mentoring staff and ensuring compliance with coding and reimbursement guidelines.