Data Mining Specialist

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 execute advanced data mining and AI-driven analytics strategies to detect overpayments and improper payments.

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

• Convert healthcare regulations, reimbursement methodologies, and clinical policies into scalable audit algorithms and analytic rules.

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

• Offer strategic and technical guidance in designing, implementing, and expanding data mining and AI-enabled analytics solutions.

• Collaborate with engineering, clinical, operations, and client teams to provide 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 verification of claims data accuracy and payment accuracy.

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

• Strong ability to translate business and policy requirements into technical and analytical solutions.

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

• Video cameras must be utilized during all interviews and the initial week of orientation.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career advancement.

• Access to technical credentials and certifications.

• Generous and flexible vacation policy.

• Educational assistance programs.

• Leadership and technical development academies.

• 401(k) employer matching.

• Comprehensive health benefits package.

• Occasional travel opportunities (0-10%).