Manager, Data Mining - Payment Integrity
Core
Lead a data mining team and manage vendors to ensure savings and recovery targets are met in the post-payment payment integrity space.
Role type
Manager, Data Mining (Payment Integrity)
Builds
Savings and recovery identification programs for health insurance members
Domain
Health Insurance / Payment Integrity
Deliverable
production ML models | dashboards & analysis
Required skills
Team leadership, vendor management, workflow design, healthcare operations, SQL, compliance
Preferred skills
Payment integrity experience, healthcare claims adjudication, medical coding certification (CPC, COC, CCS, RHIT, RHIA)
Technologies
SQL
Responsibilities
Oversee quality control for vendor submissions, lead daily team operations, develop team workflows, train and mentor team members, partner with tech/data science teams on algorithm development
Seniority
Manager, hands-on IC with team leadership