Quality Analyst – Data Mining
MedReview Inc.
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Conduct thorough quality assessments of healthcare claims data, focusing on identifying overpayments through data mining techniques.
- Develop, implement, and execute quality assurance plans and test cases specific to healthcare claims data mining.
- Collaborate with data analysts and business partners to analyze claims data for potential overpayments and ensure compliance with client policies.
- Identify and document any discrepancies or anomalies in claims data, coordinating with cross-functional teams for resolution.
- Conduct root cause analysis on detected overpayments and develop reports summarizing findings and recommendations for process improvements.
- Monitor and evaluate data mining processes, providing innovative solutions to enhance data accuracy and quality assurance in healthcare claims.
- Prepare and present detailed quality assurance reports and metrics to stakeholders, highlighting trends and areas for improvement.
- Foster strong working relationships with various business partners, ensuring effective communication and collaboration on claims data integrity initiatives.
Requirements
- High school diploma and or an advanced degree or certifications in Healthcare.
- Minimum of 5 years of experience in healthcare claims processing, data mining, or related roles, with a specific focus on post-pay overpayment analysis.
- Proven experience in quality assurance processes and methodologies, particularly in the context of healthcare claims data.
- Proficiency in O365 applications (Excel, Word, PowerPoint, Teams) for data management and report generation.
- Strong understanding of healthcare claims regulations, compliance standards, and payment integrity processes.
- Excellent analytical and problem-solving skills with the ability to interpret complex claims data.
- Effective communication and interpersonal skills, with experience collaborating with multiple business partners.
- Knowledge of coding schemes such as CPT, ICD-10, and HCPCS is beneficial.
- Experience working with and interpreting medical reimbursement and CMS policy is required.
Benefits
- Health insurance
- Professional development
- Flexible work arrangements
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data miningquality assuranceroot cause analysisclaims processingoverpayment analysisdata managementreport generationcoding schemesmedical reimbursementCMS policy
Soft Skills
analytical skillsproblem-solving skillscommunication skillsinterpersonal skillscollaborationrelationship building
Certifications
Healthcare certifications