Advisor Data Sciences
About The Position
As an Advisor Data Sciences, you will provide strategic and technical leadership in designing, implementing, and scaling advanced data mining and AI-enabled analytics solutions that identify improper payments and improve claims accuracy across medical, dental, and pharmacy domains. This role blends deep healthcare payment integrity expertise, advanced data mining and AI capabilities, and delivery leadership. You will translate complex State, Federal, and client-specific reimbursement policies into scalable analytics, guide cross-functional teams through complex implementations, and ensure successful delivery of high-impact payment integrity solutions for Gainwell clients. You will act as a content authority, product owner, and delivery leader, partnering with engineering, clinical, operations, and client teams to safeguard healthcare resources for vulnerable populations.
Requirements
- 7+ years of Healthcare Payment Integrity, Data Mining, or Advanced Analytics experience.
- Demonstrated experience in healthcare payment integrity data mining, including validation of claims data accuracy and payment accuracy.
- Proven experience applying CMS regulations, State/Federal guidelines, coding standards, and reimbursement policies to claims analytics.
- Strong experience translating business and policy requirements into technical and analytical solutions.
- Hands-on experience with AI/ML-driven analytics, such as predictive modeling, anomaly detection, pattern recognition, or NLP applied to healthcare or financial data.
Responsibilities
- Act as Product Owner, Delivery Lead, and Implementation Manager for complex data mining and analytics initiatives.
- Design, develop, and implement advanced data mining and AI-driven analytics concepts to identify overpayments and improper payments.
- Support and lead responses to client RFPs, contributing superior written content related to data mining, AI, and payment integrity capabilities.
- Translate complex healthcare regulations, reimbursement methodologies, and clinical policies into scalable audit algorithms and analytic rules.
- Lead the incorporation of AI, machine learning, and advanced analytics techniques into payment integrity solutions.
Benefits
- work flexibility
- learning
- career development
- technical credentials and certifications
- generous, flexible vacation policy
- educational assistance
- comprehensive leadership and technical development academies
- 401(k) employer match
- comprehensive health benefits
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
