Data Mining Ideation Specialist

Job description

Position Summary: As a Data Mining Ideation Specialist, you will leverage your deep expertise in medical coding requirements, claims adjudication processes, and reimbursements methodologies to design and develop data mining audits that drive payment accuracy across our clients Medicaid, Medicare, and Commercial lines of business. This role is ideal for someone who thrives at the intersection of coding, analytics, and audit development. Someone who can translate complex reimbursement policies into actionable audit concepts that identify improper payments with a high degree of precision and consistency. You will apply strong analytical thinking, an in-depth understanding of claims data, and meticulous attention to detail to uncover overpayment opportunities and build scalable audit logic. In close partnership with audit, analytics, and operations teams, you will define data selection parameters, validate outcomes, and continuously refine audit strategies to improve accuracy and impact. This role also plays a key part in supporting production audit teams through training, guidance, and ongoing quality initiatives. This is a remote role. Salary Range 80-100K depending upon experience....