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Data Mining Analyst - Remote (Anywhere US)
Job ID R25910
Date posted 03/23/2022
Data Mining Analyst
Overview of Position
The HealthCare Senior Data Mining Analyst position is responsible for developing new and existing audit concepts, gaining client acceptance, and ensuring proper claims selection. The goal of the position is to generate high quality recoverable claims for the benefit of our clients. Conducts and documents complex audit projects independently. This is a senior skill level position. Considered a mentor, trainer, developer of less tenured Audit team members.
What will be my duties and responsibilities in this job?
Utilizes healthcare and auditing experience to perform audits that identify payment issues on medium to complex audit concepts.
Leader in concept development. This includes identifying the concept, development of audit techniques, creating provider descriptions of audit findings, and interacting with client to obtain concept approval.
Assists in development of new audit tools and processes.
Fosters and implements new ideas, approaches, and technological improvements to support and enhance audit production, communication, and client satisfaction.
Provides support for quality controls by performing reviews all level auditor claims prior to and after client submission.
Prepares responses to client and provider disputes.
Makes determinations based on advanced experience of client knowledge of contract terms.
Assist in assessment of provider acceptance and likelihood of recovery.
Performs contract modeling and testing in companies contract compliance application.
Assist in the development of monthly financial targets and responsible for meeting those goals
Assists in potential audit potential assessment for potential clients.
Assists in development of internal and external reports and presentations.
What are the requirements needed for this position?
5+ years audit experience with extensive knowledge of Commercial, Medicare and Medicaid payment policies
What critical skills are needed for you to consider someone for this position?
Healthcare billing and reimbursement methodology knowledge
Knowledge of CPT and ICD-10 coding
Familiarity with UB and HCFA claim forms and data
Familiarity with Institutional and Professional EDI claim data
Understanding of provider contracting and reimbursement methodologies
Understanding of payer reimbursement and billing policies
Knowledge of Medicare and/or Medicaid billing policies and regulations
Proficiency in Microsoft Office suite
Working knowledge of applicable industry-based standards
Excellent verbal and written communication skills
Ability to work well in an individual and team environment
What other skills/experience would be helpful to have?
Bachelor’s Degree preferred
Prior healthcare billing and/or claims experience desired
Ability to manipulate and analyze large data sets
Knowledge of database software
Client engagement experience preferred
Healthcare coding certifications a plus
What are the working conditions and physical requirements of this job?
General office demands/Home office
How much should I expect to travel?
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COVID Vaccination Requirements
We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.
Equal Opportunity/Affirmative Action Statement
Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.
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Talent Acquisition Process
Once you apply for a job opening, the Sourcing Specialist or Talent Advisor will review your resume ensuring your background matches the minimum job requirements. Selected candidates will be invited for a phone screen.
Steps will vary by team, but typically include: Talent Advisor phone screen, hiring manager interview, and a combination of technical screens and panel interviews.
If you're selected, you can expect the Talent Advisor to reach out with specific offer details. During this stage you will be provided with an electronic offer letter and other new hire documents.
Once you've electronically signed your offer, our onboarding team will get you ready for Week 1 and set you up for success! Onboarding tasks may include a background check, drug screening, and other job specific requirements.
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