Trainer – Quality Analyst, Data Mining, Payment Integrity

🕒 Outubro 12

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $75.000 - $90.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

📉 Analista de Dados

👻 Score fantasma 1%

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EXL

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

🛡️ Seguros

📦 Logística

💰 $2.000.000 Venture Round em 2015-01

Healthcare • Insurance • Logistics

Escolher um parceiro digital vai além das capacidades — trata-se de colaboração e caráter.

Descrição

• Facilitate training sessions, refresher education, coaching discussions, and one-on-one support • Provide training support for new and existing Data Mining auditors • Create and maintain Data Mining learning resources, job aids, tutorials, process documentation, knowledge checks, and refresher content • Assess trainee and auditor understanding through audit results, quality trends, knowledge checks, and observed performance • Perform quality control reviews of completed Data Mining audit findings • Validate claim accuracy, payment methodology, recovery opportunities, and compliance with client-specific requirements • Review provider contracts, fee schedules, claim systems, pricing references, coding guidelines, and audit notes • Validate complex claim repricing using client claims systems, pricing tools, CMS guidelines, coding resources, and program procedures • Monitor, analyze, and report error trends, root causes, pass/fail outcomes, and recurring issues • Recommend corrective actions, training opportunities, and quality improvement initiatives • Evaluate audit processes, controls, procedures, and Data Mining concepts • Review query-driven audit outputs for effectiveness, consistency, efficiency, compliance, and recovery alignment • Partner with audit leadership, trainers, quality teams, and subject matter experts on requirements, calibration, quality gaps, process improvements, procedure updates, and special projects • Ensure audit work aligns with client, program, regulatory, HIPAA, and company requirements while maintaining confidentiality

🎯 Requisitos

• High School Diploma required • Minimum 5+ years of experience in medical claims, healthcare auditing, Payment Integrity, coding, claim quality review, or related healthcare operations • Strong understanding of complex medical claim processing, provider payment methodologies, claim systems, and audit documentation requirements • Ability to interpret client requirements, provider contracts, fee schedules, coding guidelines, pricing rules, and healthcare compliance standards • Strong verbal and written communication skills • Ability to work independently, manage multiple priorities, meet deadlines, and maintain accuracy in a production-based environment • Ability to develop or deliver virtual training materials, coaching plans, process guidance, job aids, and knowledge checks • Ability to translate complex claims, audit, repricing, quality, and compliance concepts into clear virtual training content • Extensive knowledge of medical claims processing, healthcare reimbursement, provider payment logic, and overpayment recovery concepts • Strong understanding of CMS pricing and reimbursement guidelines, provider contract interpretation, fee schedules, coding resources, and healthcare compliance standards • Knowledge of CPT, HCPCS, ICD-10-CM, and medical coding methodologies • Ability to review query-driven audit outputs and understand Data Mining logic • Strong analytical and critical-thinking skills • Strong understanding of quality assurance principles, audit accuracy standards, error prevention, and structured review criteria • Confident virtual facilitation, presentation, and instructional delivery skills • Strong training development skills • Ability to assess learner comprehension, identify training gaps, and adapt virtual training content • Ability to coach auditors through audit results, quality trends, documentation issues, and corrective actions • Proficiency with Microsoft Excel, PowerPoint, Outlook, Word, spreadsheets, databases, and data analysis tools • Commitment to accuracy, quality, attention to detail, confidentiality, and compliance • College degree preferred • CPC or other nationally recognized coding certification preferred • Relevant experience may be considered in lieu of certification • Experience with Payment Integrity, healthcare reimbursement, or overpayment recovery audits preferred • Prior experience performing quality reviews, claim audits, or audit validation strongly preferred • Experience applying quality criteria, audit scorecards, accuracy standards, or structured quality review guidelines preferred • Experience with healthcare claim systems and industry tools such as FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat/Webtrat, and applicable pricers preferred • Prior experience creating virtual training programs, job aids, assessments, and support tools preferred

🏖️ Benefícios

• Exciting, fast-paced, and innovative work environment • Opportunity to work closely with experienced healthcare consultants • Exposure to multiple aspects of clients’ businesses • Teamwork and time-management development • Mentoring program with guidance and coaching from a senior-level advisor • Growth and development opportunities