Senior Data Mining Auditor
MedReview Inc.
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $90,000 - $115,000 per year
Job Level
Senior
Tech Stack
MS SQL ServerSQL
About the role
- Support Payment Integrity team members with development, implementation and maintenance of operational reports and dashboards.
- Ensure resources are accurate, up-to-date, and can be analyzed to reveal critical insights applicable to strategic initiatives.
- Produce detailed data mining reports for the Payment Integrity pillars.
- Extract critical and pertinent information from the data sets that help the stakeholders understand optimal outcomes.
- Effectively process and integrate primary and/or secondary data sources using database warehouse and visual applications.
- Develop effective quality control processes to ensure data integrity.
- Utilize data analytics to reveal critical business insights and findings.
- Create and deploy PI edits and algorithms to flag suspect claims and drive savings.
- Perform ad-hoc analysis to quantify and prioritize potential savings opportunities.
- Triage PI referrals from local markets, HCE, Clinical Affordability to assess risk.
- Build and provide sustainable audit processes that ensure overpayment findings accuracy.
- Assist with concept development.
- Drive opportunities to standardize process and enhance account management reporting.
- Optimize technology solutions to enhance quality, minimize errors, and expedite issue resolution.
- Work with team leadership to communicate challenges and recommended solutions.
- Work with data mining leadership to communicate operations needs to executive leadership.
Requirements
- Seven (7) years of medical claims investigation or data mining, 5 years in a leadership role
- Demonstrated healthcare claims industry expertise.
- Attainment of relevant medical billing and coding certification along with a bachelors' degree in a relevant field are both highly preferred.
- Minimum high school diploma or GED.
- Problem solving and solutions focused.
- Attention to detail, and commitment to client satisfaction.
- Comfortable interpreting data and developing meaningful insights, analytical mindset.
- Experience with developing measures for performance and quality measurement.
- Strong oral and written communication skills
- Aptitude to quickly learn software platforms such as MS SQL Server, Power BI, and other tools.
- Knowledge of coding type edits and medical claim reimbursement structures and methodologies
- Proficiency with medical terminology, medical procedures, medical conditions, and illness and treatment practices
- Experience in applying principles of coding guidelines; federal/state regulations and policies pertaining to coding and billing.
- Knowledge in researching state and federal healthcare guidelines, e.g., Medicare and State Medicaid Programs
- Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (e.g., Facets, QNXT, etc.)
- Advanced computer skills and proficiency with Microsoft Excel.
- Mature professional with ability to work independently in remote work settings.
Benefits
- Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
- 401(k) with Employer Match - Join the team and we will invest in your future
- Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
- Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
- Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data miningdata analyticsquality control processesmedical billing and codingperformance measurementcoding guidelinesmedical claim reimbursementdata integrationad-hoc analysisalgorithm development
Soft skills
problem solvingattention to detailclient satisfactionanalytical mindsetcommunication skillsleadershipindependent workprocess standardizationstrategic thinkingcollaboration
Certifications
medical billing certificationmedical coding certificationbachelor's degreehigh school diplomaGED