Payment Integrity Analyst - Data Mining
Experience Requirements:
Minimum of one (1) year of combined experience in healthcare (health insurance, claims processing, etc.).
Minimum of one (1) year experience auditing medical claims to identify improper payments.
Minimum of one (1) year of experience performing data analytics with large data sets.
Minimum of one (1) year of experience in medical billing codes (CPT, ICD-10, HCPCS, etc.).
Other Requirements:
Applicants must already be legally authorized to work in the U.S.
Ability to maintain confidentiality and comply with HIPAA and data security standards.
Responsibilities:
Review and work assigned Data Mining leads to determine verification steps and next actions.
Investigate and validate payment terms using internal systems and payer portals.
Create clear, detailed, and accurate case notes capturing verification steps and outcomes.
Track outcomes and error categories to identify root causes of recurring issues.
Reconcile discrepancies across eligibility feeds, member data, and claim history.
Show more details
