Data Mining Specialist – Payment Integrity

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $93.9k - $134.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 2%

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

📦 Logistics

💰 $2M Venture Round on 2015-01

Healthcare • Insurance • Logistics

EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data.

📋 Description

• Access client claim systems to validate claim reimbursement terms • Review client contract systems or files for contractual reimbursement terms • Create overpayment rules for data mining • Analyze payer data and identify anomalies or aberrant billing practices • Review client accounts to determine whether correct payments were made to providers • Reprice complex claims using multiple client claims systems • Identify work files for audit through a query process • Document audit findings for client review • Serve as a resource for junior auditors and new employees • Identify and develop or validate overpayment opportunities and recovery concepts • Serve as a client- and program-specific subject matter expert • Evaluate procedures and recommend process improvements • Perform duties in accordance with company compliance, information security, and regulatory policies

🎯 Requirements

• Minimum of 5 years employment within Payment Integrity Services • Minimum 5-8 years or equivalent work experience in healthcare/payment integrity/managed care contracts • Experience with Medicare, Medicaid, and Commercial claims data • Experience with industry systems: FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat, and Pricers • Sound knowledge of ICD-10, CPT, and HCPC coding guidelines • Experience processing complex medical health claims • Knowledge of CMS Pricing Guidelines and Coding Methodologies • Excellent computer skills; proficiency in Excel, Word, and Outlook • Bachelor’s degree or equivalent work experience in Payment Integrity services

🏖️ Benefits

• Exciting, fast paced and innovative environment • Opportunity to work closely with highly experienced, world class analytics consultants • Exposure to multiple aspects of clients’ businesses • Teamwork and time-management skills development • Mentoring program with senior-level professional advisors • Growth and development opportunities

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