Operations Manager, Data Mining

Job Summary

Driving strategic ideation and optimizing resource utilization, the full-time Operations Manager, Data Mining will focus on automating business processes and improving operational efficiency while working remotely from anywhere in the U.S.

Key responsibilities:

• Ensure timely data acquisition and accuracy while managing audit production efficiency
• Maintain ideation pipeline and drive timely recoveries through effective strategic planning
• Communicate with and develop staff while providing reporting to internal and external stakeholders

Required qualifications:

• 4+ years of experience in healthcare, health insurance, payer operations, claims, or payment integrity
• 2+ years of experience with healthcare coding guidelines, reimbursement policies, and payment methodologies
• Proven understanding of healthcare claim adjudication and payer workflows
• Demonstrated understanding of EDI data, including 837 claim submission and 835 payment/remittance data
• Proven knowledge of healthcare payment methodologies and proficiency in Microsoft Office software