Remote Senior Data Mining Auditor - Payment Integrity

MedReview; Oregon; Hybrid; USD 85,000 - 90,000; Full time

Job summary

MedReview seeks a Data Mining Senior Auditor to identify cost-savings opportunities through advanced data mining strategies, claims analysis, and payment integrity initiatives within its Payment Integrity team.

The role requires strong analytical skills, deep knowledge of healthcare claims processing and reimbursement methodologies, and the ability to transform complex data into actionable insights that drive client savings.

Qualifications

• 7+ years experience in healthcare claims investigation, payment integrity, or data mining.
• 5+ years leadership experience within healthcare auditing, payment integrity, or related functions.
• Strong analytical, critical thinking, and problem-solving skills.
• Experience developing performance measures and quality assurance methodologies.
• Advanced proficiency with Microsoft Excel.
• Ability to quickly learn and utilize SQL Server, Power BI, and related analytics platforms.
• Knowledge of Medicare, Medicaid, and commercial payer reimbursement requirements.

Responsibilities

• Develop, implement, and maintain data mining strategies that identify claims overpayments and cost-saving opportunities.
• Create and deploy payment integrity edits, algorithms, and auditing methodologies to flag suspect claims and drive recoveries.
• Perform detailed claims analyses to identify trends and opportunities for enhanced savings initiatives.
• Develop and maintain operational reports, dashboards, and performance metrics.
• Collaborate with Payment Integrity, Clinical, Operations, and Analytics teams to support organizational objectives.

Skills

Healthcare claims

Data mining

Leadership

Excel

SQL

Power BI

Auditing

Payment integrity

Regulations

Coding guidelines

Medicare/Medicaid

HIPAA

Remote work

Communication

Education

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

Tools

SQL Server

Power BI

Facets

QNXT

Job description

MedReview seeks a Data Mining Senior Auditor to identify cost-savings opportunities through advanced data mining strategies, claims analysis, and payment integrity initiatives within its Payment Integrity team.

The role requires strong analytical skills, deep knowledge of healthcare claims processing and reimbursement methodologies, and the ability to transform complex data into actionable insights that drive client savings.