Senior Data Mining, Payment Integrity Analyst

🕒 il y a 2 mois

🤠 Texas – Distant

🤠 Texas – Remote

💵 $69 400 - $99 200 / an

⏰ Temps Plein

🟠 Senior

🧐 Analyste

🦅 Parrain de Visa H1B

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Gainwell Technologies

Site WebLinkedInTous les Emplois

10 000+ employés

⚕️ Assurance santé

💰 Grant en 2023-06

Healthcare Insurance • Human Services • Healthcare

Gainwell Technologies est le principal fournisseur national de solutions numériques et en mode cloud dans l'écosystème des services sociaux et de la santé publique. Avec une approche axée sur les missions, Gainwell sert des clients dans les 50 états américains, en se concentrant sur l'amélioration des résultats de santé et la fourniture d'expériences intuitives centrées sur l'humain. Leur gamme complète de solutions comprend la modernisation de l'entreprise Medicaid, l'analyse de données, les services aux prestataires et les solutions pharmaceutiques, toutes conçues pour faire progresser l'avenir des soins de santé et améliorer le bien-être communautaire.

Description

• Develop and implement new data mining opportunities to identify overpayments to providers through data review and analytics across dental, medical, and pharmacy claims • Act as a senior member of the team and mentor lower-level analysts • Research industry standard guidelines, State and Federal regulations, and client billing and reimbursement policies to develop and configure improper payment algorithms • Review provider contracts to identify algorithms for the identification of contract-based overpayments • Implement current Payment Analytics concepts for new and existing clients while ensuring client policy is supportive and properly applied • Support the appeals, validation, and client services teams in resolving outstanding issues related to production queries • Ensure individual and departmental goals are consistently met or exceeded through collaboration with other team members and management • Review IT programming results for quality assurance and proof of concept validation • Document query results and prepare internal and external documentation and presentations related to new overpayment issues • Partner with internal operations and clinical teams to develop, implement, review, and audit protocols and internal review guidelines • Collaborate with engineers to develop and implement technological improvements that support the audit process • Contribute innovative ideas for improving existing audit processes and audit queries

🎯 Exigences

• 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 the Accuracy of Claims Payment, is preferred • Experience Applying Published Healthcare Guidelines such as CMS Regulations and Coding Guidelines to Healthcare Claims Data • Recovery audit experience is preferred

🏖️ Avantages

• generous, flexible vacation policy • educational assistance • comprehensive health benefits • 401(k) employer match • comprehensive leadership and technical development academies