Payment Integrity Data Mining Ideation SME
Tasks
- Analyze yield and appeal statistics
- Collaborate with audit analytics and operations teams
- Define data selection requirements
- Develop data mining audits for payment accuracy
- Develop logic specifications for new concepts
- Identify improper payments
- Maintain medical coding guideline expertise
- Monitor audit performance and assess logic revisions
- Provide training for audit staff
- Support client approvals and ad hoc requests
- Translate regulatory standards into audit logic
- Validate audit output accuracy
Perks/Benefits
Skills/Tech-stack
3M Encoder | APC | CMS policies | CPT | Claims Processing | Commercial Insurance | DRG | Data Analysis | EAPG | EDI 835 | EDI 837 | Excel | HCPCS | ICD-10 | MUE | Medicaid | Medical coding | Medicare | NCCI edits | Payment integrity | Ptp | Python | Reimbursement Methodologies | SQL | WEBSTRAT
Education
N/A
Related jobs
-
Business Analytics Senior Analyst - EviCore - Remote USD 68K-113KData Cleansing | Data Documentation | Data Validation | Databricks | ETL401k | Dental insurance | Health insurance | Life insurance | Paid HolidaysSenior-level Full TimeSouth Carolina Work at Home, United … R1d ago
-
Educational Data Analytst USD 110K-120KDashboard Design | Data Modeling | Data Quality | Data Visualization | Data integration401k matching | Flexible PTO | Gym reimbursement | Health insurance | Paid sick time offMid-level Full TimeRemote - US R1d ago
-
High School Enrollment Specialist USD 40K-54KCRM | Data Integrity | Data entry | Database Management | Ellucian BannerEntry-level Full TimeColorado Springs, CO R1d ago
-
Data Analytics Investor Reporting - Associate USD 70K-100KAirbyte | DBT | Data Analysis | Data Modeling | Data ValidationDental insurance | Employer-Matched Retirement Plan | Flexible remote work Friday | Parental leave | Subsidized healthcareMid-level Full TimeSalt Lake City, Utah, United States R1d ago
-
Business Intelligence | Dashboard Development | Data Analysis | Data Modeling | Data QualityMentorship | Remote work | Some onsite as neededSenior-level Full TimeUnited States R1d ago
-
Manager, Commercial Analytics & Insights - Neuro USD 122K-152KA/B | A/B Testing | B testing | Claims data | Data Visualization401k matching | Dental insurance | Disability insurance | Employee assistance program | Employee stock purchase planMid-level Full TimePrinceton, New Jersey, United States; San … R1d ago
-
Dashboard Development | Data Modeling | Data Visualization | Excel | Power BIRemote eligibleMid-level Full TimeSan Antonio, TX, United States R1d ago
-
Senior-level Full TimeRemote, United States R1d ago
-
Mortgage Transfer Data Analyst III USD 42K-71KClient Communication | Data Analysis | Data Integrity | Data Mapping | Data Testing401k match | Employee recognition programs | Employee stock purchase plan | Gym membership discounts | Mental health resourcesSenior-level Full TimeUnited States R1d ago
-
Sr. Data Analyst (part-time, hybrid) USD 124K-165KAPIs | AWS | Azure | Azure Data | Azure Data LakeHybrid work | Part-time hoursSenior-level Full Time Part TimeArlington, VA, United States R1d ago
-
Data Analyst USD 70K-75KData Modeling | Data Transformation | Data Visualization | Data cleaning | Excel401k plan | Flexible in-office schedule | Gym discounts | Life insurance | Long-term disability insuranceMid-level Full TimeAtlanta, Georgia R1d ago
-
People Analytics Analyst USD 98K-150KCorrelation | Data Analysis | Employee Listening | Employee lifecycle | ExcelDental insurance | Employee assistance program | Flexible spending account | Health insurance | Health savings accountMid-level Full TimeMountain View Technical Center - Mountain … R2d ago
-
Senior-level Full TimeRemote, TX, United States R2d ago
-
Cloud Data Specialist - Applications Developer USD 130K-206KAWS | Algorithms | Azure | CI/CD | Data StructuresHybrid work schedule | Inclusive culture | Professional development opportunities | Supportive leadersSenior-level Full TimeLouisville - West Market, United States R2d ago
-
C# | MATLAB | NumPy | Pandas | PythonPart-time project-based workSenior-level Full TimeNew York, New York, United States … R2d ago
-
Alteryx | Automation | Data analytics | Dataset analysis | EmbeddingsHybrid work schedule | On-site work 3 days per week | Remote work 2 days per weekSenior-level Full Time144039-NC-550 S Tryon, United States R2d ago
-
Energy Analyst- Analytics (REMOTE) USD 74K-125KEnergy Efficiency | Excel | IF statements | Pivot Tables | Python401k matching | Donation matching | Employee stock purchase plan | Flexible workplace arrangements | Professional development resourcesMid-level Full TimeNationwide Remote Office (US99), United States R2d ago
-
Service Delivery Center, Data Analyst - Senior USD 65K-152KAb Initio | DB2 | DBMS | Data Quality | Data Visualization401k plan | Coaching and mentoring | Dental insurance | Medical insurance | Paid time offSenior-level Full TimeDallas, TX, US, 75270 R2d ago
-
Analyst 3, Business Performance Analytics USD 73K-117KExperiment design | Machine Learning | Power BI | Python | R401k matching | Dental insurance | Medical insurance | Paid time off | Vision insuranceMid-level Full TimeChicago IL, United States R2d ago
-
Senior Data Analyst USD 80K-120KAWS | Agile | Azure | Dashboarding | Data Analysis401k | Comprehensive medical, dental, vision & life insurance | Employee stock purchase plan | Flexible time off | Hybrid work scheduleSenior-level Full TimeUSA - NC - Durham - … R2d ago
-
AI tools | Anomaly Detection | Data Analysis | Data Interpretation | Data QualityFlexible paid time off | Health, dental and vision coverage | Remote work flexibilityEntry-level Full TimeCalifornia R2d ago
-
People Data Analyst USD 75K-136KData Analysis | Data Compliance | Data Visualization | Excel | Pivot TablesAnnual wellness and community outreach days | Comprehensive benefits | Flexible time off | Flexible work environment | Global collaboration and networking opportunitiesMid-level Full TimeSunnyvale, CA, United States R2d ago
-
Data Analyst (Remote) USD 60K-110KData Validation | Data Visualization | Data cleaning | Excel | Key Performance Indicators401k match | Dental insurance | Health insurance | Health savings account | Paid HolidaysMid-level Full TimeRemote - Any, United States R2d ago
-
Senior Compensation & Analytics Manager USD 123K-213KAI tools | ATS | Automation | Benchmarking | Compensation ManagementFamily planning support | Flexible time off | Lifestyle stipend | Mental health support | Paid parental leaveSenior-level Full TimeRemote, US R2d ago
-
Data Analyst, Data Cloud Intelligence USD 85K-95KAWS | Attribution | Business Intelligence | Data Modeling | Data pipelineEmployee discounts | Employee equity | Medical, dental & vision coverage | Pet insurance | Stock purchase planMid-level Full TimeRemote - US R2d ago