Data Mining Consultant

Job Summary

A company is looking for a Data Mining Consultant to analyze healthcare claims and reimbursement policies.

Key Responsibilities

• Review external payer data files to identify overpayment opportunities based on reimbursement policies
• Communicate outcomes to external payer clients through monthly collaboration and governance calls
• Direct the reporting and analysis team on new analytic opportunities to enhance client value

Required Qualifications

• 3+ years of experience in healthcare claim processes and reimbursement policies
• 1+ years of experience in data analysis and medical claim overpayment calculation
• Experience with CPT & ICD coding
• Ability to review payer reimbursement policies for adherence to payment activity
• Experience in calculating overpayment expectations for clients