The Data Mining Senior Auditor is responsible for developing and implementing data mining strategies to identify healthcare cost-savings and overpayments. They will perform detailed claims analysis, create audit algorithms, and collaborate with cross-functional teams to drive operational efficiency and financial performance.
The Pricing Resolution Processor II is responsible for reviewing, grouping, and pricing healthcare facility claims to identify overpayments and ensure reimbursement accuracy. They must maintain compliance with regulatory guidelines and contractual obligations while meeting departmental productivity and quality standards.
The coder performs claim-level outpatient coding reviews to identify inaccurate billing, documentation gaps, and potential overpayments. They are responsible for documenting audit rationale clearly and ensuring findings align with payer policies and coding guidelines.
The Vice President of Account Management will build and lead the account management function while overseeing strategic client relationships to drive retention and revenue growth. This role involves establishing consistent service standards, coaching team members, and serving as the primary escalation point for client issues.
The Director of Account Management serves as the primary relationship partner for an assigned portfolio of clients, coordinating communication and service performance. They are responsible for identifying growth opportunities, resolving complex issues, and leading business reviews to ensure client satisfaction and retention.
The DRG Reviewer is responsible for analyzing inpatient medical records and claims to validate coding accuracy and ensure appropriate DRG assignment. They collaborate with physician reviewers to identify reimbursement opportunities and maintain compliance with regulatory and industry standards.
The Senior Director of Account Management will lead the day-to-day management of complex enterprise client relationships and serve as a strategic partner to client leaders. They are responsible for overseeing account performance, driving retention and growth, and coordinating cross-functional teams to ensure consistent service delivery.
The Data Mining Ideation Specialist identifies and develops audit concepts to ensure payment accuracy across Medicaid, Medicare, and Commercial lines of business. They collaborate with cross-functional teams to define data selection parameters, validate audit results, and maintain expertise in healthcare coding and reimbursement policies.
The Physician Reviewer will perform DRG clinical validation reviews to ensure accurate diagnoses and compliance with evidence-based guidelines. They will also produce clinical summaries and collaborate with internal teams to support documentation accuracy and healthcare quality.
