Senior Data Mining, Payment Integrity Analyst

🕒 April 13

🤠 Texas – Remote

🤠 Texas – Remote

💵 $69.4k - $99.2k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 45%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Design and develop data mining concepts to identify improper payments and improve claims accuracy across dental, medical, and pharmacy billing • Develop and implement data mining opportunities to identify provider overpayments through claims review and analytics • Mentor lower-level analysts • Research industry guidelines, State and Federal regulations, and client billing and reimbursement policies • Develop and configure improper payment algorithms • Review provider contracts to identify contract-based overpayments • Implement Payment Analytics concepts for new and existing clients • Support appeals, validation, and client services teams in resolving production query issues • Review IT programming results for quality assurance and proof-of-concept validation • Document query results and prepare internal and external documentation and presentations • Partner with operations and clinical teams to develop, implement, review, and audit protocols and internal review guidelines • Collaborate with engineers on technological improvements supporting the audit process • Contribute ideas to improve audit processes and audit queries

🎯 Requirements

• 5 years of Healthcare Payment Integrity and/or Data Mining experience • At least 3 years of domain-specific experience in Medical, Dental, or Pharmacy claims analysis • Experience in healthcare auditing, including reviewing and validating the accuracy of claims data and claims payment (preferred) • Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data • Recovery audit experience (preferred) • Video cameras must be used during all interviews and during the initial week of orientation

🏖️ Benefits

• Work flexibility • Learning and career development opportunities • Technical credentials and certifications • Generous, flexible vacation policy • Educational assistance • Leadership and technical development academies • 401(k) employer match • Comprehensive health benefits • Opportunities to travel through your work (0-10%)