Data Mining Specialist

Job not on LinkedIn

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $99.2k - $141.7k / year

⏰ Full Time

🟠 Senior

🔴 Lead

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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

• Act as Product Owner, Delivery Lead, and Implementation Manager for complex data mining and analytics initiatives • Design, develop, and implement advanced data mining and AI-driven analytics concepts to identify overpayments and improper payments • Support and lead responses to client RFPs, contributing written content related to data mining, AI, and payment integrity capabilities • Translate healthcare regulations, reimbursement methodologies, and clinical policies into scalable audit algorithms and analytic rules • Lead incorporation of AI, machine learning, and advanced analytics techniques into payment integrity solutions • Provide strategic and technical leadership in designing, implementing, and scaling data mining and AI-enabled analytics solutions • Partner with engineering, clinical, operations, and client teams to deliver payment integrity solutions

🎯 Requirements

• 7+ years of Healthcare Payment Integrity, Data Mining, or Advanced Analytics experience • Demonstrated experience in healthcare payment integrity data mining, including validation of claims data accuracy and payment accuracy • Experience applying CMS regulations, State/Federal guidelines, coding standards, and reimbursement policies to claims analytics • Strong experience translating business and policy requirements into technical and analytical solutions • Hands-on experience with AI/ML-driven analytics, such as predictive modeling, anomaly detection, pattern recognition, or NLP applied to healthcare or financial data • Video cameras must be used during all interviews and 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 • Occasional travel opportunities (0-10%)