Mr. C Miami - Coconut Grove · 1 month ago
Senior Data Mining Auditor
United States
Full-time
Remote
Senior Level
$90K/yr - $115K/yr
7+ years expMr. C Miami - Coconut Grove is seeking a Senior Data Mining Auditor to join their team. This role involves identifying medical cost savings for healthcare insurance clients through the development and implementation of data mining strategies and ensuring that operational and financial goals are met.
Hospitality
Responsibilities
Support Payment Integrity team members with development, implementation and maintenance of operational reports and dashboards
Ensure resources are accurate, up-to-date, and can be analyzed to reveal critical insights applicable to strategic initiatives
Produce detailed data mining reports for the Payment Integrity pillars
Extract critical and pertinent information from the data sets that help the stakeholders understand optimal outcomes
Effectively process and integrate primary and/or secondary data sources using database warehouse and visual applications
Develop effective quality control processes to ensure data integrity
Utilize data analytics to reveal critical business insights and findings
Create and deploy PI edits and algorithms to flag suspect claims and drive savings
Perform ad-hoc analysis to quantify and prioritize potential savings opportunities
Triage PI referrals from local markets, HCE, Clinical Affordability to assess risk
Build and provide sustainable audit processes that ensure overpayment findings accuracy
Assist with concept development
Drive opportunities to standardize process and enhance account management reporting
Optimize technology solutions to enhance quality, minimize errors, and expedite issue resolution
Work with team leadership to communicate challenges and recommended solutions
Work with data mining leadership to communicate operations needs to executive leadership
Qualification
Required
Seven (7) years of medical claims investigation or data mining, 5 years in a leadership role
Demonstrated healthcare claims industry expertise
Minimum high school diploma or GED
Problem solving and solutions focused
Attention to detail, and commitment to client satisfaction
Comfortable interpreting data and developing meaningful insights, analytical mindset
Experience with developing measures for performance and quality measurement
Strong oral and written communication skills
Aptitude to quickly learn software platforms such as MS SQL Server, Power BI, and other tools
Knowledge of coding type edits and medical claim reimbursement structures and methodologies
Proficiency with medical terminology, medical procedures, medical conditions, and illness and treatment practices
Experience in applying principles of coding guidelines; federal/state regulations and policies pertaining to coding and billing
Knowledge in researching state and federal healthcare guidelines, e.g., Medicare and State Medicaid Programs
Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (e.g., Facets, QNXT, etc.)
Advanced computer skills and proficiency with Microsoft Excel
Mature professional with ability to work independently in remote work settings
Preferred
Attainment of relevant medical billing and coding certification along with a bachelors' degree in a relevant field are both highly preferred
Benefits
Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
401(k) with Employer Match - Join the team and we will invest in your future
Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.
Company
Mr. C Miami - Coconut Grove
From the fourth generation hospitality leaders, brothers Ignazio and Maggio Cipriani, comes Mr. C Miami Coconut Grove.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase