Gainwell Technologies · 8 hours ago
Data Mining Content Ideation Senior Professional
Texas, United States
Contract
Onsite
Mid, Senior Level
$69K/yr - $99K/yr
5+ years expGainwell Technologies is dedicated to improving the health and well-being of vulnerable populations through innovative technology solutions. The Data Mining Content Ideation Senior Professional will design and develop data mining concepts to enhance claims accuracy and identify improper payments across various healthcare billing domains.
Health CareInformation Technology
Responsibilities
Develop and implement new data mining opportunities to identify overpayments to providers through data review and analytics across dental, medical, and pharmacy claims
Act as a senior member of the team and mentor lower-level analysts
Research industry standard guidelines, State and Federal regulations, and client billing and reimbursement policies to develop and configure improper payment algorithms
Review provider contracts to identify algorithms for the identification of contract-based overpayments
Implement current Payment Analytics concepts for new and existing clients while ensuring client policy is supportive and properly applied
Support the appeals, validation, and client services teams in resolving outstanding issues related to production queries
Ensure individual and departmental goals are consistently met or exceeded through collaboration with other team members and management
Review IT programming results for quality assurance and proof of concept validation
Document query results and prepare internal and external documentation and presentations related to new overpayment issues
Partner with internal operations and clinical teams to develop, implement, review, and audit protocols and internal review guidelines
Collaborate with engineers to develop and implement technological improvements that support the audit process
Contribute innovative ideas for improving existing audit processes and audit queries
Qualification
Required
5 years of Healthcare Payment Integrity and/or Data Mining experience
At least 3 years of Domain Specific experience in Medical, Dental, or Pharmacy claims analysis
Preferred
Experience in Healthcare Auditing, including Reviewing and Validating the Accuracy of Claims Data and the Accuracy of Claims Payment
Experience Applying Published Healthcare Guidelines such as CMS Regulations and Coding Guidelines to Healthcare Claims Data
Recovery audit experience
Benefits
Generous, flexible vacation policy
A 401(k) employer match
Comprehensive health benefits
Educational assistance
A variety of leadership and technical development academies to help build your skills and capabilities
Company
Gainwell Technologies
Gainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital.
10001+ employees
H1B Sponsorship
Gainwell Technologies has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (90)
2024 (78)
2023 (56)
2022 (96)
2021 (33)
Funding
Current Stage
Late StageTotal Funding
$1M2023-06-06Grant· $1M
Leadership Team
Paul N. Saleh
President and Chief Executive Officer
Gary Call
Chief Medical Officer
Recent News
bloomberglaw.com
2025-12-12
GlobeNewswire
2025-12-11
Company data provided by crunchbase