Trainer – Quality Analyst, Data Mining, Payment Integrity

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $75k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📉 Data Analyst

👻 Ghost score 1%

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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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

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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