Mr. C Miami - Coconut Grove · 14 hours ago
Quality Analyst – Data Mining
United States
Full-time
Remote
Senior Level
5+ years expMr. C Miami - Coconut Grove is looking for a skilled Quality Analyst to join their Payment Integrity team, specializing in Healthcare Claims Data Mining. The ideal candidate will ensure the quality and accuracy of healthcare claims data, focusing on post-pay overpayment analysis and collaborating with various business partners.
Hospitality
Responsibilities
Conduct thorough quality assessments of healthcare claims data, focusing on identifying overpayments through data mining techniques
Develop, implement, and execute quality assurance plans and test cases specific to healthcare claims data mining
Collaborate with data analysts and business partners to analyze claims data for potential overpayments and ensure compliance with client policies
Identify and document any discrepancies or anomalies in claims data, coordinating with cross-functional teams for resolution
Conduct root cause analysis on detected overpayments and develop reports summarizing findings and recommendations for process improvements
Monitor and evaluate data mining processes, providing innovative solutions to enhance data accuracy and quality assurance in healthcare claims
Prepare and present detailed quality assurance reports and metrics to stakeholders, highlighting trends and areas for improvement
Foster strong working relationships with various business partners, ensuring effective communication and collaboration on claims data integrity initiatives
Qualification
Required
High school diploma and or an advanced degree or certifications in Healthcare
Minimum of 5 years of experience in healthcare claims processing, data mining, or related roles, with a specific focus on post-pay overpayment analysis
Proven experience in quality assurance processes and methodologies, particularly in the context of healthcare claims data
Proficiency in O365 applications (Excel, Word, PowerPoint, Teams) for data management and report generation
Strong understanding of healthcare claims regulations, compliance standards, and payment integrity processes
Excellent analytical and problem-solving skills with the ability to interpret complex claims data
Effective communication and interpersonal skills, with experience collaborating with multiple business partners
Experience working with and interpreting medical reimbursement and CMS policy is required
Preferred
Knowledge of coding schemes such as CPT, ICD-10, and HCPCS is beneficial
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