Healthcare Data Analyst – Algorithm Developer

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

📋 Description

• Examine healthcare claims, encounter, provider, and medical record-related data to uncover trends, anomalies, outliers, and potential risks in coding or billing compliance.

• Create, test, validate, and sustain algorithms, business rules, and SQL queries utilized in supporting coding reviews, audit targeting, payment integrity, and compliance monitoring efforts.

• Convert coding, reimbursement, and policy requirements into data logic that flags records, claims, or providers for additional scrutiny.

• Assist in the development of analytical models and rule sets associated with CPT, HCPCS, ICD-10, modifiers, place of service, units, and other elements of claims.

• Evaluate data outputs for precision, reasonableness, and alignment with review objectives, audit scopes, and program policies.

• Collaborate with coders, auditors, clinicians, and compliance personnel to grasp review requirements and translate them into consistent analytic methodologies.

• Detect patterns concerning documentation deficiencies, claim errors, utilization anomalies, denial trends, overpayment risks, and indicators of potential fraud, waste, and abuse.

• Prepare data files, summaries, scorecards, dashboards, and reports for internal stakeholders, audit teams, and program leadership.

• Aid in record selection methodologies for audits, sampling, monitoring, and focused reviews using claims and related data.

• Conduct data validation, quality checks, reconciliation tasks, and root cause analysis to ensure the reliability of analytic outputs.

• Record query logic, technical methods, assumptions, and validation steps in a clear and reproducible manner.

• Support ad hoc analyses related to coding accuracy, reimbursement trends, provider billing patterns, and policy modifications.

• Assist in maintaining reference tables, edit logic, provider attributes, coding crosswalks, and other data assets used in analytics.

• Monitor the effects of coding and regulatory updates on data logic, algorithms, and analytic reporting.

• Work with internal stakeholders to enhance audit efficiency, targeting accuracy, and reporting clarity.

• Adapt swiftly to shifting priorities, evolving business rules, and new review requirements while meeting deadlines and upholding quality.

⛳️ Requirements

• Bachelor’s degree in data analytics, health information management, informatics, public health, healthcare administration, statistics, computer science, or a related field is preferred.

• A minimum of 2 years of experience in healthcare data analysis, claims analysis, payment integrity, program integrity, revenue cycle analytics, or similar roles is preferred.

• Proficient experience with SQL is required, including the ability to write complex queries, join large datasets, aggregate results, and validate outputs.

• Familiarity with medical coding concepts, such as CPT, HCPCS, and ICD-10, is strongly preferred.

• Experience with healthcare claims or encounter data is required; Medicaid experience is strongly preferred.

• Knowledge of healthcare billing, reimbursement, documentation review, audit support, or compliance monitoring is preferred.

• Experience in developing logic models, analytic rules, dashboards, or automated reporting solutions is preferred.

• Proficiency in Microsoft Excel is required; experience with data visualization and reporting tools is preferred.

• Strong analytical, critical thinking, problem-solving, and organizational abilities.

• Capability to communicate technical findings effectively to non-technical audiences.

• Excellent attention to detail and capacity to manage multiple datasets, priorities, and deadlines.

• Ability to work independently as well as collaboratively in a fast-paced setting.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible working hours

• Paid time off

• Remote work options