Data Mining Auditor

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

📋 Description

• Perform thorough evaluations of both pre and post pay claims by utilizing claims data, client adjudication systems, payment guidelines, regulatory standards, contracts, pricing systems, medical records, authorizations, and other accessible resources.

• Act as a claims billing and payment authority and a resource for data teams and various departments.

• Collaborate with the team to develop and enhance reimbursement policies and procedures.

• Stay informed about the latest billing guidelines and regulations.

• Meet the expected accuracy and quality standards for valid claim identification and documentation.

• Carry out additional tasks as assigned or necessary to support the business.

⛳️ Requirements

• 3-5 years of relevant experience.

• Capability to review payment details against Medicare and payer billing guidelines to assess the appropriateness of payments.

• Experience or certification in coding/billing is advantageous.

• Ability to meet deadlines consistently.

• Willingness and capability to take necessary actions to fulfill workload demands.

• Commitment to delivering high-quality work is essential.

• Strong attention to detail; investigative and deductive reasoning skills are essential.

• Must be able to make decisions and draw conclusions when working with limited information using reference materials and robust problem-solving skills.

• Proficient in Excel, Word, Gmail, Google Sheets, Slack, and similar tools.

• Capable of thriving in a fast-paced environment and adapting to rapid changes and growth.

• Preferred: Experience in post-pay data mining auditing.

• Preferred: Experience in pre-pay data mining.

• Preferred: Experience in payer auditing.

🏝️ Benefits

• Work from anywhere in the US! Machinify operates with a digital-first approach.

• Comprehensive Medical/Dental/Vision benefits.

• Flexible Spending Account (FSA) / Health Savings Account (HSA).

• Tuition reimbursement program.

• Competitive salary package.

• 401(k) plan with company matching.

• Additional health and wellness benefits and perks.

• Flexible and trusting work environment where you will feel empowered to excel in your role.