HealthCare - Senior Data Mining Analyst
Company: Change Healthcare
Posted on: May 6, 2021
Transforming the future of healthcare isnt something we take
lightly. It takes teams of the best and the brightest, working
together to make an impact.As one of the largest healthcare
technology companies in the U.S., we are a catalyst to accelerate
the journey toward improved lives and healthier communities.Here at
Change Healthcare, were using our influence to drive positive
changes across the industry, and we want motivated and passionate
people like you to help us continue to bring new and innovative
ideas to life.If youre ready to embrace your passion and do what
you love with a company thats committed to supporting your future,
then you belong at Change Healthcare.Pursue purpose. Champion
innovation. Earn trust. Be agile. Include all.Empower Your Future.
Make a Difference.The HealthCare Senior Data Mining Analyst
position is responsible for developing new and existing audit
concepts, gaining client acceptance and ensuring proper claims
selection. The goal of the position is to generate high quality
recoverable claims for the benefit of our clients. Conducts and
documents complex audit projects independently. This is a senior
skill level position. Considered a mentor, trainer, developer of
less tenured Audit team members.
- Generates and Develops New Audit Concepts. Utilizes healthcare
and auditing experience to perform audit procedures that include
identifying and defining issues, developing criteria, reviewing and
analyzing evidence with the intent to audit standard medium and
complex reports. Leader in concept development. This includes
specifying the concept, interact with client to test and gain
acceptance. Will execute on the expansion of the concept based on
customer requirements. Focused on growing concept approval.
- Develops New Tools and Processes. Fosters and implements new
ideas, approaches, and technological improvements to support and
enhance audit production, communication and client
- Directs ownership for Quality Control. Reviews all level
auditor claims prior to and after client submission.
- Prepares Responses to Client Disputes. Makes determinations
based on advanced experience of client knowledge of contract terms,
likelihood of acceptance recovery.
- Reviews provider Contracts. Subject matter expert in contracts
and research requirements. Implements recommendations on contracts
to fit projects within standard reports such as medical policies,
state and federal statutes.
- Validates New Claim Types. With proficiency, utilizes audit
tools to evaluate, document and validate to audit and client new
claims and concept effectiveness. Ensures that any new and existing
concepts are achieving desired goals in terms of recoveries,
collectability and client acceptance.
- Performs contract modeling and testing in companies contract
- Assist in the development of monthly financial targets and
responsible for meeting those goalsWhat we are looking for:
- Bachelor's degree eight (8) years of audit experience.
- Expert in BCBS claims processing.
- Extensive knowledge of Commercial, Medicare Advantage and
Medicaid payment policies.
- Computer proficiency in Microsoft Excel.
- Prior Healthcare Billing and/or claims experience desired.
Requires working knowledge of and applicable industry based
- Excellent verbal and written communication skills.
- Ability to work well in an individual and team environment.What
will I be responsible for in this job? (brief summary of the
role)The HealthCare Senior Data Mining Analyst position is
responsible for developing new and existing audit concepts, gaining
client acceptance and ensuring proper claims selection. The goal of
the position is to generate high quality recoverable claims for the
benefit of our clients. Conducts and documents complex audit
projects independently. This is a senior skill level position.
Considered a mentor, trainer, developer of less tenured Audit team
members.What are the requirements? Years of experience: 8
Education: Bachelor's Degree Physical requirements: NAWhat critical
skills are needed for you to consider someone for this
position?Medical Billing and Coding ExperienceContract Compliance
KnowledgeCommercial, Medicaid, and Medicare Advantage Policy
UnderstandingWhat other skills/experience would be helpful to
have?Excel ExperienceHow much should I expect to travel?
NAEmployees in roles that require travel will need to be able to
qualify for a company credit card or be able to use their own
personal credit card for travel expenses and submit for
reimbursement.Join our team today where we are creating a better
coordinated, increasingly collaborative, and more efficient
healthcare system!Equal Opportunity/Affirmative Action Statement
Change Healthcare is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard
to race, color, religion, age, sex, sexual orientation, gender
identity, genetic information, national origin, disability, or
veteran status. To read more about employment discrimination
protections under federal law, read EEO is the Law at and the
supplemental information at .If you need a reasonable accommodation
to assist with your application for employment, please contact us
by sending an email to firstname.lastname@example.org
"Applicant requesting reasonable accommodation" as the subject.
Resumes or CVs submitted to this email box will not be
accepted.Click here to view our pay transparency nondiscrimination
policy.Change Healthcare maintains a drug free workplace and
conducts pre-employment drug-testing, where applicable, in
accordance with federal, state and local laws.
Keywords: Change Healthcare, Wichita , HealthCare - Senior Data Mining Analyst, Healthcare , Wichita, Kansas
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