Trainer – Quality Analyst, Data Mining, Payment Integrity

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

📋 Description

• Conduct training sessions, refresher education, coaching discussions, and offer individualized support.

• Provide training assistance for both new and existing Data Mining auditors.

• Develop and maintain Data Mining learning resources, job aids, tutorials, process documentation, knowledge assessments, and refresher content.

• Evaluate trainee and auditor comprehension through audit outcomes, quality trends, knowledge assessments, and observed performance.

• Execute quality control reviews of finalized Data Mining audit findings.

• Verify claim accuracy, payment methodologies, recovery opportunities, and adherence to client-specific requirements.

• Analyze provider contracts, fee schedules, claim systems, pricing references, coding guidelines, and audit notes.

• Confirm complex claim repricing using client claims systems, pricing tools, CMS guidelines, coding resources, and program procedures.

• Observe, analyze, and report error trends, root causes, pass/fail outcomes, and recurring issues.

• Suggest corrective actions, training opportunities, and quality enhancement initiatives.

• Assess audit processes, controls, procedures, and Data Mining concepts.

• Review query-driven audit outputs for their effectiveness, consistency, efficiency, compliance, and recovery alignment.

• Collaborate with audit leadership, trainers, quality teams, and subject matter experts on requirements, calibration, quality gaps, process improvements, procedure updates, and special projects.

• Ensure audit activities comply with client, program, regulatory, HIPAA, and company requirements while maintaining confidentiality.

⛳️ Requirements

• High School Diploma is mandatory.

• At least 5+ years of experience in medical claims, healthcare auditing, Payment Integrity, coding, claim quality review, or related healthcare operations.

• Strong knowledge of complex medical claim processing, provider payment methodologies, claim systems, and audit documentation requirements.

• Ability to interpret client requirements, provider contracts, fee schedules, coding guidelines, pricing rules, and healthcare compliance standards.

• Excellent verbal and written communication skills.

• Capacity to work autonomously, manage multiple priorities, meet deadlines, and maintain precision in a production-based environment.

• Proficient in developing or delivering virtual training materials, coaching plans, process guidance, job aids, and knowledge assessments.

• Capability to translate complex claims, auditing, repricing, quality, and compliance concepts into clear virtual training content.

• Extensive understanding of medical claims processing, healthcare reimbursement, provider payment logic, and concepts related to overpayment recovery.

• Strong familiarity with CMS pricing and reimbursement guidelines, provider contract interpretation, fee schedules, coding resources, and healthcare compliance standards.

• Knowledge of CPT, HCPCS, ICD-10-CM, and medical coding methodologies.

• Ability to review query-driven audit outputs and comprehend Data Mining logic.

• Strong analytical and critical-thinking abilities.

• Profound understanding of quality assurance principles, audit accuracy standards, error prevention, and structured review criteria.

• Confident in virtual facilitation, presentation, and instructional delivery skills.

• Strong skills in training development.

• Ability to assess learner comprehension, identify training gaps, and modify virtual training content accordingly.

• Capacity to coach auditors regarding audit results, quality trends, documentation issues, and corrective actions.

• Proficiency with Microsoft Excel, PowerPoint, Outlook, Word, spreadsheets, databases, and data analysis tools.

• Commitment to accuracy, quality, attention to detail, confidentiality, and compliance.

• College degree is preferred.

• CPC or other nationally recognized coding certification is preferred.

• Relevant experience may be considered in place of certification.

• Experience with Payment Integrity, healthcare reimbursement, or overpayment recovery audits is preferred.

• Previous experience performing quality reviews, claim audits, or audit validation is strongly preferred.

• Experience in applying quality criteria, audit scorecards, accuracy standards, or structured quality review guidelines is preferred.

• Familiarity with healthcare claim systems and industry tools such as FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat/Webtrat, and relevant pricers is preferred.

• Previous experience in creating virtual training programs, job aids, assessments, and support tools is preferred.

🏝️ Benefits

• Dynamic, fast-paced, and innovative work environment.

• Opportunity to collaborate closely with seasoned healthcare consultants.

• Exposure to various aspects of clients’ businesses.

• Development of teamwork and time-management skills.

• Mentoring program offering guidance and coaching from a senior-level advisor.

• Opportunities for growth and development.