Remote Data Mining Senior Auditor - Payment Integrity

MedReview; United States; Remoto; USD 85.000 - 90.000; Tempo pieno

Descrizione del lavoro

MedReview is seeking a Data Mining Senior Auditor to identify healthcare savings through data mining, claims analysis, and audit development. The role leads data-driven strategies to uncover overpayments and improve payment integrity for health plan clients.

Responsibilities include developing audits, reporting, and collaborating with cross-functional teams to drive measurable client savings while ensuring data accuracy and compliance in a remote work environment.

Competenze

• 7+ years of healthcare claims investigation, payment integrity, or data mining experience.
• 5+ years of leadership in healthcare auditing or related functions.
• Strong knowledge of healthcare claims processing and reimbursement methodologies.
• Excellent analytical, critical thinking, and problem-solving skills.
• Experience developing performance measures and quality assurance methodologies.
• Advanced proficiency with Microsoft Excel; ability to learn SQL Server and Power BI.

Mansioni

• Develop, implement, and maintain data mining strategies to identify overpayments and savings opportunities.
• Create and deploy payment integrity edits and auditing methodologies to flag suspect claims.
• Perform detailed claims analyses to identify trends and opportunities for enhanced savings.
• Produce detailed data mining reports, dashboards, and performance metrics.
• Collaborate with cross-functional teams to support audit performance and client savings.

Conoscenze

Advanced Excel

SQL

Power BI

Critical thinking

Data analysis

Formazione

Bachelor’s degree in Health Information Management, Healthcare Administration, Data Analytics, Business

Certifications such as CPC/CCS/CPMA/RHIA/RHIT (preferred)

Strumenti

SQL Server

Power BI

Facets

QNXT

Descrizione del lavoro

MedReview is seeking a Data Mining Senior Auditor to identify healthcare savings through data mining, claims analysis, and audit development. The role leads data-driven strategies to uncover overpayments and improve payment integrity for health plan clients.

Responsibilities include developing audits, reporting, and collaborating with cross-functional teams to drive measurable client savings while ensuring data accuracy and compliance in a remote work environment.