Senior Data Mining & Payment Integrity Strategist

Gainwell Technologies; Town of Texas (WI); Hybrid; USD 69,400 - 99,200; Full time

Benefits offered by this job

Generous, flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies in Wisconsin is seeking a Senior Data Mining & Payment Integrity Analyst who will design and develop data mining concepts to improve claims accuracy. You’ll be responsible for identifying improper payments across dental, medical, and pharmacy billing while collaborating with cross-functional teams.

The ideal candidate has extensive experience in healthcare payment integrity and auditing. This role offers a generous, flexible vacation policy and a comprehensive benefits package, including 401(k) matching and educational assistance.

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 in healthcare auditing, including reviewing and validating the accuracy of claims data and the accuracy of claims payment.

Responsibilities

• Develop and implement new data mining opportunities to identify overpayments to providers.
• Act as a senior member of the team and mentor lower-level analysts.
• Research industry guidelines and develop algorithms.
• Review provider contracts for overpayment identification.
• Support the appeals, validation, and client services teams.

Job description

Gainwell Technologies in Wisconsin is seeking a Senior Data Mining & Payment Integrity Analyst who will design and develop data mining concepts to improve claims accuracy. You’ll be responsible for identifying improper payments across dental, medical, and pharmacy billing while collaborating with cross-functional teams.

The ideal candidate has extensive experience in healthcare payment integrity and auditing. This role offers a generous, flexible vacation policy and a comprehensive benefits package, including 401(k) matching and educational assistance.