Data Mining Sr. Analyst

Role overview

Responsibilities

• Lead pre- and post-payment claim reviews to identify inaccurate payments using reimbursement and contract expertise.
• Analyze provider contracts against negotiated terms, methodologies, and payer rules.
• Collaborate with engineering and data science teams to translate reimbursement logic into analytical and automation frameworks.
• Research and document reimbursement and contract patterns, coverage rules, and billing practices.
• Convert complex reimbursement and contract scenarios into structured rules and business logic for implementation.
• Analyze claim-level data to find causes of overpayments or incorrect denials and recommend corrective approaches.
• Maintain expertise on CMS and commercial payer reimbursement guidelines.
• Support quality review, concept validation, and process improvement.

Required qualifications

• At least 5 years of healthcare data mining or claims editing experience on the provider, payer, or vendor side.
• Deep understanding of provider contracts, rate structures, carve-outs, and reimbursement methodologies.
• Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers.
• Ability to identify improper payment patterns, root causes, and opportunities for correction.
• Strong investigative and deductive reasoning; able to connect policy, data, and contract details.
• Comfortable collaborating with technical teams to guide business logic implementation.
• Self-directed, detail-oriented, and adaptable in a fast-paced environment.

Preferred qualifications

• Coding certification such as CPC, CCS, or equivalent is preferred.
• Working proficiency in SQL for data exploration and validation is preferred.
• Cross-functional R&D or innovation experience focused on healthcare payment integrity is preferred.

Workplace

• Work from anywhere in the United States; the company describes itself as digital-first.

Compensation

• Listed pay range is $125,000–$135,000 per year; salary is based on factors including experience, skills, and certifications.

Benefits

• Benefits include medical, dental, and vision coverage; FSA/HSA; tuition reimbursement; 401(k) company match; and additional health and wellness benefits.