Healthcare Data Analyst – Algorithm Developer

🕒 Maio 7

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RADcube

SiteLinkedInTodas as Vagas

201 - 500 funcionários

🤖 Inteligência Artificial

🏢 Corporativo

🔒 Cibersegurança

Artificial Intelligence • Enterprise • Cybersecurity

<RADcube> é um parceiro global em tecnologia e integração de sistemas que projeta e entrega plataformas de IA prontas para produção através do RADlabs, focando em soluções governadas, seguras e em escala empresarial. A empresa desenvolve IA governada e sistemas agênticos, processamento inteligente de documentos (consciente de HIPAA), engenharia e análise de dados, computação em nuvem & DevOps, cibersegurança & GRC, e automação de processos para modernizar sistemas, operacionalizar IA e ampliar a inovação com ênfase em segurança, conformidade e IA Responsável. O RADcube atende múltiplas indústrias, incluindo governo, ciências da saúde e da vida, bancos & finanças, e-commerce, manufatura, transporte & logística, e educação.

Descrição

• Analyze healthcare claims, encounter, provider, and medical record-related data to identify trends, anomalies, outliers, and potential coding or billing compliance risks. • Develop, test, validate, and maintain algorithms, business rules, and SQL queries used to support coding reviews, audit targeting, payment integrity, and compliance monitoring activities. • Translate coding, reimbursement, and policy requirements into data logic that can be used to flag records, claims, or providers for further review. • Support development of analytical models and rule sets related to CPT, HCPCS, ICD-10, modifiers, place of service, units, and other claims elements. • Review data outputs for accuracy, reasonableness, and alignment with review objectives, audit scopes, and program policies. • Partner with coders, auditors, clinicians, and compliance staff to understand review requirements and convert those requirements into repeatable analytic approaches. • Identify patterns related to documentation deficiencies, claim errors, utilization anomalies, denial trends, overpayment risks, and potential fraud, waste, and abuse indicators. • Prepare data files, summaries, scorecards, dashboards, and reports for internal stakeholders, audit teams, and program leadership. • Support record selection methodologies for audits, sampling, monitoring, and focused reviews using claims and related data. • Perform data validation, quality checks, reconciliation activities, and root cause analysis to ensure reliability of analytic outputs. • Document query logic, technical methods, assumptions, and validation steps in a clear and reproducible manner. • Assist with ad hoc analysis related to coding accuracy, reimbursement trends, provider billing patterns, and policy changes. • Support maintenance of reference tables, edit logic, provider attributes, coding crosswalks, and other data assets used in analytics. • Monitor impacts of coding and regulatory updates on data logic, algorithms, and analytic reporting. • Collaborate with internal stakeholders to improve audit efficiency, targeting precision, and reporting clarity. • Adapt quickly to changing priorities, evolving business rules, and new review requirements while meeting deadlines and maintaining quality.

🎯 Requisitos

• Bachelor’s degree in data analytics, health information management, informatics, public health, healthcare administration, statistics, computer science, or a related field preferred. • At least 2 years of experience in healthcare data analysis, claims analysis, payment integrity, program integrity, revenue cycle analytics, or related work preferred. • Strong experience with SQL required, including writing complex queries, joining large datasets, aggregating results, and validating outputs. • Working knowledge of medical coding concepts, including CPT, HCPCS, and ICD-10, strongly preferred. • Experience working with healthcare claims or encounter data required; Medicaid experience strongly preferred. • Familiarity with healthcare billing, reimbursement, documentation review, audit support, or compliance monitoring preferred. • Experience developing logic models, analytic rules, dashboards, or automated reporting solutions preferred. • Proficiency in Microsoft Excel required; experience with data visualization and reporting tools preferred. • Strong analytical, critical thinking, problem-solving, and organizational skills. • Ability to communicate technical findings clearly to non-technical audiences. • Strong attention to detail and ability to manage multiple datasets, priorities, and deadlines. • Ability to work independently and collaboratively in a fast-paced environment.

🏖️ Benefícios

• Health insurance • 401(k) matching • Flexible working hours • Paid time off • Remote work options