Senior Data Mining & Payment Integrity Analyst – Healthcare

Gainwell Technologies LLC; Ohio; On-site; USD 69,000 - 99,000; Full time

Benefits offered by this job

Flexible vacation policy

Educational assistance

401(k) employer match

Health benefits

Leadership and technical development s

Job summary

Gainwell Technologies LLC is seeking a seasoned healthcare data professional to join our team, focusing on payment integrity and data mining to identify overpayments across dental, medical, and pharmacy claims.

You will review guidelines and contracts, develop algorithms, and support client services with QA, documentation, and stakeholder training. This role offers growth through leadership and technical development academies, competitive benefits, and flexible learning opportunities.

Qualifications

• 5 years of Healthcare Payment Integrity and/or Data Mining experience.
• At least 3 years of Domain Specific experience in Medical, Dental, or Pharmacy claims analysis.
• Experience applying Published Healthcare Guidelines such as CMS Regulations and Coding Guidelines to Healthcare Claims Data.

Responsibilities

• Develop data mining to identify provider overpayments across dental, medical, and pharmacy claims.
• Research industry guidelines and client policies to develop improper payment algorithms.
• Review provider contracts to identify algorithms for overpayments.
• Implement payment analytics concepts for new and existing clients.
• Support the appeals, validation, and client services teams in resolving production queries.
• Review IT programming results for quality assurance and proof of concept validation.
• Document query results and prepare internal and external documentation.
• Partner with operations and clinical teams to develop and audit protocols.

Skills

Data mining

Healthcare analytics

Claims analysis

Job description

Gainwell Technologies LLC is seeking a seasoned healthcare data professional to join our team, focusing on payment integrity and data mining to identify overpayments across dental, medical, and pharmacy claims.

You will review guidelines and contracts, develop algorithms, and support client services with QA, documentation, and stakeholder training. This role offers growth through leadership and technical development academies, competitive benefits, and flexible learning opportunities.