Codoxo · 1 day ago
Data Mining Auditor
United States
Full-time
Remote
Mid Level
4+ years expCodoxo is a premier provider of artificial intelligence-driven solutions in the healthcare industry, focusing on detecting and reducing risks from fraud, waste, and abuse. The Data Mining Auditor role involves performing medical claim audits to identify overpaid claims and ensuring compliance with coding guidelines and regulations.
AnalyticsArtificial Intelligence (AI)Fraud DetectionGenerative AIHealth CareMachine LearningSoftware
No H1B
Responsibilities
Perform medical claim audits by reviewing customer claims data and charges, and/or medical records, to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as customer requirements and guidelines
Draft clear, defensible audit rationales and findings documentation suitable for client review, provider outreach, and downstream recovery or action workflows
Collaborate with internal analytics and AI teams to translate clinical, coding, and regulatory requirements into audit concepts, models and deterministic review logic
Maintain excellent quality, accuracy, and high productivity levels
Keep current on medical coding guidelines
Demonstrate efficient use of relevant software tools
Participate in departmental meetings, contribute to business development initiatives and office functions
Prioritize assignments and responsibilities to meet goals and deadlines
Qualification
Required
Active coding certification from either AAPC or AHIMA is required
4+ years of work experience with a focus on healthcare provider billing and coding audits
Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements
Knowledge of various reimbursement methodologies, to include MS-DRG, APR-DRG, OPPS, per diems, case rates, and RVU calculations
Knowledge of Medicare, Medicaid and Commercial reimbursement methodologies
Comprehensive knowledge of industry standard rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation, including but not limited to NCCI edits for PTP and MUE, global services, multiple procedure reductions, and COB
Proficient user in Microsoft Office Suite
Excellent time management, organizational skills, and ability to prioritize work and meet deadlines
Exceptional verbal and written communication skills
Desire to work within a team environment
Preferred
SQL or Python experience is highly desirable but not required
Knowledge of payer claims processing systems is desirable
Familiarity with JIRA, SharePoint, and AWS is also desirable
Benefits
Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)
Unlimited PTO
Annual Professional Development stipend
Annual home office stipend
401K Match (after 90 days)
Company
Codoxo
Codoxo leverages advanced generative and self-learning AI to enhance payment integrity in healthcare.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
$49.66MKey Investors
CVS Health VenturesQED Investors
2025-12-17Series C· $35M
2025-03-01Debt Financing
2022-02-03Series B· $5.25M
Leadership Team
Musheer Ahmed
CEO & Founder
Toby Shum
Vice President, Finance @ Codoxo - AI Solutions for Healthcare
Recent News
2025-12-20
Crowdfund Insider
2025-12-20
vcnewsdaily.com
2025-12-18
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