Data Mining Auditor

🔥 20 minutes ago

🇺🇸 United States – Remote

💵 $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Machinify

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 $10M Series A - Machinify on 2018-10

Healthcare • Consulting • Logistics

Machinify is a healthcare-focused AI platform and services company that reshapes healthcare payments and payment integrity. Its AI operating system unifies claims, medical records, contracts, and policies, and uses foundation models and task-specific agents to automate and improve coding, payment accuracy, recoveries, and cost avoidance. Machinify serves health plans (including 18 of the top 20), supports insourced, hybrid, or fully-managed deployments, and emphasizes measurable outcomes — reporting 85+ customers, 270M member lives covered, and $6B+ in annual cost avoidance and recoveries.

📋 Description

• Conduct comprehensive reviews of pre and post pay claims using claims data, client adjudication systems, payment guidelines, regulatory requirements, contracts, pricing systems, medical records, authorizations, and other available resources. • Serve as a claims billing and payment expert and resource for data teams and other departments. • Develop and refine reimbursement policies and procedures in collaboration with the team. • Remain updated with the latest billing guidelines and regulations. • Achieve expected accuracy and quality levels for valid claim identification and documentation. • Perform additional responsibilities as assigned or needed to support the business.

🎯 Requirements

• 3-5 years of relative experience. • Ability to review payment information against Medicare and payer billing guidelines to make determinations relating to the appropriateness of payments. • Experience or certification in coding/billing is helpful. • Ability to meet deadlines. • Willingness and ability to do whatever is necessary to accomplish workload demands • Delivery of high-quality work is critical. • Strong attention to detail; investigative and deductive reasoning skills are a must. • Must be able to make decisions and conclusions when working with limited information using reference materials and strong problem-solving skills. • Must be proficient in Excel, Word, Gmail, Google Sheets, Slack, etc. • Able to work in a fast-paced environment and adapt to rapid change and growth. • Preferred: Post-Pay data mining auditing experience. • Preferred: Pre-Pay data mining experience. • Preferred: Payer auditing experience.

🏖️ Benefits

• Work from anywhere in the US! Machinify is digital-first. • Top Medical/Dental/Vision offerings • FSA/HSA • Tuition reimbursement • Competitive salary • 401(k) with company match • Additional health and wellness benefits and perks • Flexible and trusting environment where you’ll feel empowered to do your best work

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