HealthCare - Senior Data Mining Analyst

Company: Change Healthcare
Location: Wichita
Posted on: May 6, 2021

Job Description:

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 satisfaction.
• 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 compliance application.
• 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 standards.
  • 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 applyaccommodations@changehealthcare.comwith "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