Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse. Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques.
We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry.
Position Summary
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We are seeking a highly skilled and detail-oriented Data Mining Manager to join our Payment Integrity team. This role recognizes and reports new and existing payment integrity data mining concepts for development with minimum assistance. The person might be tasked to multiple clients and/or programs. They also understand the data mining process and will occasionally be tasked with training and assistance on process improvements. The successful candidate will utilize advanced data mining techniques to detect, analyze, and prevent improper payments, including fraud, waste, abuse, and errors in billing and claims processing.
Key Responsibilities
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Serve as a data mining and Payment Integrity subject matter expert
Research new concepts for development to determine applicability to client requirements.
Effectively utilize department tools to research concepts as appropriate, including but not limited to:
Client Claims Processing Policies/Systems
CMS/OIG/RAC Public Information
Provider/Member Contracts
State Medicaid Plans Public Information
Codoxo’s Platform and Query Capability
Clients Payment policies
Prior knowledge of effective data mining concepts.
Document new concepts in an appropriate format for Codoxo developers
Partners with Microsoft SQL and Python developers to develop efficient output of concept following concept development Process.
Aid in the training and mentorship of existing and new team members as appropriate.
Document how to validate overpayments at a conceptual level.
Aid in the documentation of concept approval forms for clients as necessary.
Serve as a subject matter expert for Codoxo’s Data Mining platform and services.
Qualifications:
CPC or other coding certification required
Minimum of 5 years of data mining experience required
Proven experience in payment integrity healthcare data mining and data analysis
Proficiency in data mining tools and software such as SQL, Python, R, SAS, or similar a plus
Strong analytical skills with the ability to interpret complex data sets.
Excellent communication skills, both written and verbal, with the ability to present complex information clearly.
Knowledge of regulatory requirements related to payment integrity and data privacy.
Knowledge of payment systems, healthcare claims, and financial transactions.
Knowledge of edits and pricing logic, reimbursement methodologies for Medicare and Medicaid
CPT, HCPCP and ICD-10 coding and pricing
Knowledge of payer policies and provider contracting methodologies
Strong attention to detail and problem-solving skills.
Meticulous in data analysis and reporting to ensure accuracy.
Benefits for You
Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)
Unlimited PTO
Annual Professional Development stipend
Annual home office stipend
401K Match (after 90 days)
We are an Equal Opportunity Employer
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Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment.