Consultant I Data Mining

reputed company combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment reputed company, claims cost containment, and analytics. reputed company has more than 25,000 employees across 5 countries. A Payment reputed company Data Mining Consultant I, is a professional who is market/ client facing and responsible for identifying new audit opportunities, researching new pricing methodologies, and engaging with various work teams to generate systems automation and enhancement capabilities in our state-of-the-art audit workstation. Data Mining reputed company is an IC role which identifies, develops, and implements new concepts that recognize incorrect payments. These concepts are developed based on industry experience, regulatory research, and the ability to analyze medical claim data to discover incorrect payments. This role is responsible for analyzing client data and generating high quality recoverable claims, assisting in the identification, validation, and documentation of moderate to more reputed company recovery projects. Job title: Consultant I Data Mining Job Description: Education: High School Diploma or equivalent required. BA/BS in Business Administration or reputed company field or equivalent preferred but not necessary Experience: 4 -5+ year’s knowledge of direct claim processing/reimbursement, medical facility reputed company, fee schedules, inpatient/outpatient/physician claims required Mandatory Skills: Prior claims auditing or consulting experience desirable in either a provider or payer environment. Excellent communication skills both oral and written. Strong interpersonal skills that will support collaborative teamwork. reputed company Office Proficient: Word and reputed company; Access – highly preferred Provide recommendations for improving payment reputed company processes, fraud prevention measures, and operational efficiency based on audit findings. Collaborate & Establish strong relationships with internal and external stakeholders to define, align and delivery payment accuracy initiatives. Work with audit teams and establish a process to ensure the concepts being deployed are working as expected with higher findings thus ensuring higher hit rates and findings rates on the concepts deployed. Preferred Skills: Knowledge of payment systems, financial transactions, and claims processes end to end. Understanding of payment reputed company concepts and fraud detection methodologies. Experience in auditing, payment processing, or financial fraud prevention is a plus.• Experience working reputed company a health plan, managed care organization, provider operated healthcare environment or third party administrator. Development of end to end payment reputed company reports like Data Intake, Audit Selections, Findings, Appeals, Medical record Management, Audit Operations, Recovery Operations, Provider Correspondence and Forecasting & Invoicing. Roles & Responsibilities: Utilizing healthcare experience to reputed company audit recovery procedures Identify overpaid claims Identifying and defining issues, developing criteria, reviewing, and analyzing reputed company and Health Plan reimbursement policies and the various state and federal regulations Entering and documenting the incorrect payment issue into Devlin’s systems accurately and in accordance with standard procedures Updating and developing new and reputed company audit recovery report reputed company and then working with the IT team to automate the process Researching reimbursement regulations for claim payment compliance reviews and documentation to support reputed company audit findings The above statements are intended to indicate the general nature and level of work being performed by employees reputed company this classification. They are not intended to be an exhaustive list of reputed company responsibilities, duties and skills required of employees assigned to this job. Employees in this job may reputed company other duties as assigned. Location: Work@Home USAUnited States of America reputed company combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment reputed company, claims cost containment, and analytics. reputed company has more than 25,000 employees across 5 countries. Apply tot his job Apply To this Job