Data Mining Auditor

Machinify

9h • Remote

About The Position

Machinify is seeking an Auditor for pre- and/or post-pay data mining to conduct claims audits for Machinify customers. The role also supports product testing, quality enhancements, and related work to ensure customer satisfaction. The ideal candidate has a strong background in healthcare claims auditing, claims processing and coding, and an understanding of CMS and commercial payer payment guidelines. This is a digital-first role that can be performed from anywhere in the United States.

Requirements

• 3–5 years of relevant experience.
• Ability to review payment information against Medicare and payer billing guidelines and determine whether payments are appropriate.
• Ability to meet deadlines.
• Willingness and ability to meet workload demands as needed.
• High-quality work and strong attention to detail.
• Investigative and deductive reasoning skills.
• Ability to make decisions and reach conclusions with limited information, using reference materials and strong problem-solving skills.
• Proficiency in Excel, Word, Gmail, Google Sheets, Slack, and similar tools.
• Ability to work in a fast-paced environment and adapt to rapid change and growth.

Nice To Haves

• Experience or certification in coding or billing.
• Post-pay data mining auditing experience.
• Pre-pay data mining experience.
• Payer auditing experience.

Responsibilities

• Conduct comprehensive reviews of pre- and post-pay claims using available resources, including claims data and client adjudication systems, payment guidelines, regulatory requirements, contracts, pricing systems, medical records, and authorizations.
• Serve as a claims billing and payment expert and provide support to data teams and other departments.
• Develop and refine reimbursement policies and procedures in collaboration with the team.
• Stay up to date with billing guidelines and regulations.
• Meet audit accuracy and quality expectations for valid claim identification and documentation.
• Support the business with additional responsibilities as assigned or needed.

Benefits

• Medical, dental, and vision offerings.
• FSA/HSA.
• Tuition reimbursement.
• Competitive salary.
• 401(k) with company match.
• Additional health and wellness benefits and perks.
• Flexible and trusting work environment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed