Senior Data Mining Auditor - Healthcare Pay Integrity Remote

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

Job summary

MedReview, a leader in payment integrity, seeks a Data Mining Senior Auditor in the United States to identify cost-saving opportunities through advanced data mining, claims analysis, audit development, and payment integrity initiatives.

The role requires strong analytical skills and deep knowledge of healthcare claims processing to transform complex data into actionable insights that support client savings and operational goals. Remote work is supported.

Qualifications

• Seven years+ experience in healthcare claims investigation, payment integrity, or data mining.
• Five years+ leadership experience in healthcare auditing or related functions.
• Strong analytical and problem-solving skills.
• Knowledge of Medicare, Medicaid, and commercial payer reimbursement.
• Experience with healthcare payer systems like Facets, QNXT, or similar.

Responsibilities

• Develop, implement, and maintain data mining strategies to identify overpayments and savings opportunities.
• Create and deploy payment integrity edits, algorithms, and auditing methodologies.
• Perform detailed claims analyses to identify trends and opportunities for savings.
• Develop new audit concepts and payment integrity programs.
• Produce detailed data mining reports and dashboards for operations.

Skills

Healthcare claims analysis

Data mining

Leadership

Excel

SQL Server

Power BI

Verbal and written communication

Education

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

Tools

SQL Server

Power BI

Job description

MedReview, a leader in payment integrity, seeks a Data Mining Senior Auditor in the United States to identify cost-saving opportunities through advanced data mining, claims analysis, audit development, and payment integrity initiatives.

The role requires strong analytical skills and deep knowledge of healthcare claims processing to transform complex data into actionable insights that support client savings and operational goals. Remote work is supported.