Quality Analyst – Data Mining
MedReview Inc.Highlight
Summary
About the Role
About You
- High school diploma and/or an advanced degree or certifications in Healthcare.
- Minimum of 5 years of experience in healthcare claims processing, data mining, or related roles, with a specific focus on post-pay overpayment analysis.
- Proven experience in quality assurance processes and methodologies, particularly in the context of healthcare claims data.
- Proficiency in O365 applications (Excel, Word, PowerPoint, Teams) for data management and report generation.
- Strong understanding of healthcare claims regulations, compliance standards, and payment integrity processes.
- Excellent analytical and problem-solving skills with the ability to interpret complex claims data.
- Effective communication and interpersonal skills, with experience collaborating with multiple business partners.
- Experience working with and interpreting medical reimbursement and CMS policy.
- Knowledge of coding schemes such as CPT, ICD-10, and HCPCS.
MedReview is a different type of payment integrity company. As a physician-led organization, our doctors review and document every claim we reassign, resulting in the highest savings per review and the lowest appeal overturn rate in the industry. Our advanced algorithms are enriched by machine learning and decades of clinical and claims data, enabling us to target claims with the highest potential for inaccuracy and abuse. With a passion for ensuring claims fairly represent the care provided, MedReview offers pre- and post-pay billing audits with clinical reviews that save millions of dollars a year for our clients. Our full range of services include industry-leading solutions in payment integrity, utilization management and quality assurance.