Manager, Data Mining – Payment Integrity

This is a fully remote position, open to applicants in Illinois, +5 more states.

📋 Description

• Guide a team of individual contributors to achieve savings and recovery objectives.

• Supervise data mining auditors in the post-payment integrity sector.

• Manage vendor relationships for data mining initiatives.

• Ensure quality control for submissions from data mining vendors.

• Direct daily operations of the data mining team and strategically allocate tasks to internal auditors and external collaborators.

• Create team workflows and guidelines that yield consistent, measurable results.

• Provide training, guidance, and mentorship to team members.

• Collaborate with technology and/or data science teams to develop algorithms for identifying savings and recovery opportunities.

• Adhere to relevant laws and regulations.

• Execute other assigned responsibilities.

• Report to the Associate Director of Payment Integrity.

⛳️ Requirements

• A bachelor’s degree or 4+ years of relevant experience.

• Over 4 years of experience in healthcare operations.

• More than 2 years of experience in leading and developing a team.

• At least 2 years of experience in designing, implementing, and enhancing business workflows.

• Bonus: Over 2 years of payment integrity experience in a health plan or vendor organization.

• Bonus: Experience with healthcare claims adjudication.

• Bonus: Familiarity with SQL and basic SQL skills.

• Bonus: Medical coding certification from AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA).

🏝️ Benefits

• Employee benefits.

• Unlimited vacation program.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• Participation in the 401(k) plan.

• Life insurance.

• Disability insurance.

• Paid wellness time.

• Wellness reimbursements.