Senior Healthcare Data Mining & Payment Integrity Lead

Gainwell Technologies LLC; Columbus (OH); On-site; USD 69,000 - 99,000; Full time

Benefits offered by this job

Flexible vacation policy

Educational assistance

Leadership academies

Job summary

Gainwell Technologies LLC is seeking a Senior Data Mining & Payment Integrity Analyst to design and implement data mining concepts that identify improper payments across dental, medical, and pharmacy billing. You will translate healthcare policies into scalable audit solutions and collaborate with cross-functional teams to improve claims accuracy.

The role requires 5 years in Healthcare Payment Integrity or Data Mining, 3+ years in medical/dental/pharmacy claims analysis, and familiarity with

Qualifications

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

Responsibilities

• Design and develop data mining concepts to identify improper payments.
• Collaborate with cross-functional teams to support client payment integrity strategies.
• Mentor junior analysts and document audit results.

Skills

Healthcare Payment Integrity

Data Mining

Claims Analysis

Mentoring

Job description

Gainwell Technologies LLC is seeking a Senior Data Mining & Payment Integrity Analyst to design and implement data mining concepts that identify improper payments across dental, medical, and pharmacy billing. You will translate healthcare policies into scalable audit solutions and collaborate with cross-functional teams to improve claims accuracy.

The role requires 5 years in Healthcare Payment Integrity or Data Mining, 3+ years in medical/dental/pharmacy claims analysis, and familiarity with