Data Sciences Advisor

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 analytics strategies to detect overpayments and improper payments.

• Support and lead client RFP responses by contributing written content related to data mining, AI, and capabilities in payment integrity.

• Convert healthcare regulations, reimbursement methods, and clinical policies into scalable audit algorithms and analytical rules.

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

• Provide strategic and technical direction in the design, implementation, and scaling of advanced data mining and AI-enabled analytics solutions.

• Navigate cross-functional teams through complex implementations to ensure the successful delivery of payment integrity solutions.

• Collaborate with engineering, clinical, operations, and client teams to protect healthcare resources.

⛳️ 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 and payment accuracy.

• Demonstrated ability to apply CMS regulations, State/Federal guidelines, coding standards, and reimbursement policies in claims analytics.

• Strong capability in translating 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 are required to be used during all interviews and throughout the initial week of orientation.

🏝️ Benefits

• Flexible working arrangements.

• Opportunities for learning and career growth.

• Access to technical credentials and certifications.

• A 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.