Advisor, Data Mining, Content Ideation

This is a fully remote position, open to applicants in United States.

📋 Description

• Serve as the Product Owner, Delivery Lead, and Implementation Manager for intricate data mining and analytics projects.

• Create, develop, and implement sophisticated data mining and AI-driven analytical concepts aimed at detecting overpayments and improper payments.

• Support and spearhead responses to client RFPs, contributing written content related to data mining, AI, and payment integrity capabilities.

• Convert healthcare regulations, reimbursement methodologies, and clinical policies into scalable auditing algorithms and analytical rules.

• Lead the integration of AI, machine learning, and advanced analytical techniques into payment integrity solutions.

• Offer strategic and technical leadership in the design, implementation, and scaling of data mining and AI-enhanced analytics solutions.

• Collaborate with engineering, clinical, operations, and client teams to deliver payment integrity solutions.

⛳️ Requirements

• Over 7 years of experience in Healthcare Payment Integrity, Data Mining, or Advanced Analytics.

• Proven experience in healthcare payment integrity data mining, including the validation of claims data accuracy and payment correctness.

• Familiarity with applying CMS regulations, State/Federal guidelines, coding standards, and reimbursement policies to claims analytics.

• Strong capability in translating business and policy requirements into technical and analytical solutions.

• Practical experience with AI/ML-driven analytics, including predictive modeling, anomaly detection, pattern recognition, or NLP applied to healthcare or financial data.

• Ability to work remotely from anywhere in the U.S.

• Video cameras are required during all interviews and throughout the initial week of orientation.

🏝️ Benefits

• Flexible work options.

• Opportunities for learning and career development.

• Technical credentials and certification support.

• Generous and flexible vacation policy.

• Educational assistance programs.

• Leadership and technical development academies.

• Occasional travel opportunities (0-10%).

• 401(k) employer matching.

• Comprehensive health benefits.