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greenhouse

Data Mining Auditor

Machinify
USA
Mid · 3–5 years experience
Onsite
$85,000
Discovered 1 weeks ago

Full Job Posting

What You’ll Do

  • Conduct comprehensive reviews of pre and post pay claims using any and all available resources, including but not limited to, claims data and client adjudication systems, payment guidelines and compliance with regulatory requirements, contract, pricing systems, medical records, authorizations, etc.
  • Serve as a claims billing and payment expert, and resource for the data teams and other departments.
  • Develop and refine reimbursement policies and procedures in collaboration with the team.
  • Remain updated with the latest billing guidelines and regulations.
  • Achieve the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation.
  • Additional responsibilities as assigned or needed to support the business.

What You Bring

  • 3-5 years of relative experience.
  • Ability to review payment information against Medicare and payer billing guidelines to make determinations relating to the appropriateness of payments.
  • Experience or certification in coding/billing is helpful.
  • Ability to meet deadlines.
  • Willingness and ability to do whatever is necessary to accomplish workload demands
  • Delivery of high-quality work is critical.
  • Strong attention to detail; investigative and deductive reasoning skills are a must.
  • Must be able to make decisions and conclusions when working with limited information using reference materials and strong problem-solving skills.
  • Must be proficient in Excel, Word, Gmail, Google Sheets, Slack, etc.
  • Able to work in a fast-paced environment and adapt to rapid change and growth.
  • Preferred Experience:
  • Post-Pay data mining auditing experience
  • Pre-Pay data mining experience
  • Payer auditing experience

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