Data Mining AnalystOverview 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?
What are the requirements needed for this position?
- 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 critical skills are needed for you to consider someone for this position?
- 5+ years audit experience with extensive knowledge of Commercial, Medicare and Medicaid payment policies
What other skills/experience would be helpful to have?
- 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 are the working conditions and physical requirements of this job?
- 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
- Presentation skills
- Healthcare coding certifications a plus
How much should I expect to travel?
- General office demands/Home office
Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!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
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