Data Mining Auditor
At a glance
Mid-level Audit & Controls role at Machinify. United States · full-time · $85,000 base.
financeroles summary, based on the employer's posting.
What you'll do
- Review claims before or after payment, checking claim data, payer systems, medical records, authorizations and applicable rules
- Guide data teams and other departments on claims billing and payment questions
- Work with teammates to create and improve reimbursement policies and procedures
- Track changes to billing rules and meet the audit’s standards for accurate claim decisions and documentation
- Help test products and improve quality alongside your audit work
What you bring
- Three to five years of relevant experience
- You can compare payment details with Medicare and payer billing rules to assess whether claims were paid appropriately
- You’re proficient in Excel, Word, Gmail, Google Sheets and Slack
- You bring careful investigative judgment, sound problem-solving and the ability to meet deadlines
Who this fits
This role suits someone with healthcare claims auditing, processing or coding experience, including familiarity with CMS and commercial payer payment rules. It can be done from anywhere in the US.
From the employer
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.
- 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
- 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
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