Data Mining Auditor
Remote · USFull-time$85K/yrSeen 6 days agoSeen in employer's feed 6 days ago
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Job overview
Machinify seeks an Auditor to conduct pre- and/or post-pay data-mining claims audits for its customers. The role also supports product testing and quality enhancements. The ideal candidate has a strong background in healthcare claims auditing, claims processing and coding, and understanding of CMS and commercial payer payment guidelines. The position is work-from-anywhere in the US and offers a stated salary of $85,000 per year.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Experience Required
3 - 5 years
Minimum Education Required
High School Diploma/G.E.D.
Compensation
$85,000.00 - $85,000.00 / yearly
Hours Per Week
40
Number Of Positions
1
Work Schedule and Shift Requirements
First (Day)
Job Description
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
Machinify is seeking an Auditor for pre and/or post pay data mining to conduct claims audits on behalf of Machinify's customers. In addition, the Auditor will assist in product testing, quality enhancements, and related tasks to ensure customer satisfaction.
The ideal person for this role has a strong background in healthcare claims auditing, claims processing and coding, and a high level of understanding of payment guidelines for CMS and commercial payers.
What You'll Do:
Conduct comprehensive reviews of pre and post pay claims using any and all available resources, including but not limited to, claims data and client adjudication systems, payment guidelines and compliance with regulatory requirements, contract, pricing systems, medical records, authorizations, etc.
Serve as a claims billing and payment expert, and resource for the data teams and other departments.
Develop and refine reimbursement policies and procedures in collaboration with the team.
Remain updated with the latest billing guidelines and regulations.
Achieve the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation.
Additional responsibilities as assigned or needed to support the business.
What You Bring:
3-5 years of relative experience.
Ability to review payment information against Medicare and payer billing guidelines to make determinations relating to the appropriateness of payments.
Experience or certification in coding/billing is helpful.
Ability to meet deadlines.
Willingness and ability to do whatever is necessary to accomplish workload demands
Delivery of high-quality work is critical.
Strong attention to detail; investigative and deductive reasoning skills are a must.
Must be able to make decisions and conclusions when working with limited information using reference materials and strong problem-solving skills.
Must be proficient in Excel, Word, Gmail, Google Sheets, Slack, etc.
Able to work in a fast-paced environment and adapt to rapid change and growth.
Preferred Experience:
Post-Pay data mining auditing experience
Pre-Pay data mining experience
Payer auditing experience
What We Offer:
Work from anywhere in the US! Machinify is digital-first.
Top Medical/Dental/Vision offerings
FSA/HSA
Tuition reimbursement
Competitive salary, 401(k) with company match
Additional health and wellness benefits and perks
Flexible and trusting environment where you'll feel empowered to do your best work
The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc.
Pay range: $85,000
Equal Employment Opportunity at Machinify
We are committed to equal employment opportunity regardless of r ace, color, ancestry, r eligion, s ex, national origin, s exual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at:https://www.machinify.com/candidate-privacy-notice/
Equal Opportunity Employer
Veteran Friendly Employer
Job Type
Full time
Benefits Offered
Not specified
Veteran Preference
No
Place of Work
On-site
Requisition ID
4470749009
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