Auditor III - Data Mining

EXL Health is looking for a Data Mining Auditor lll. This is 100% remote work from home opportunity!   In this role you will collaborate with Payment Integrity Audit program leaders to assist clients in controlling healthcare costs by performing Data Mining Audit reviews. The successful candidate will be passionate, quality focused and have a background in Payment Integrity Audits and Medical Claims Processing/Pricing. The Data Mining Auditor is responsible for performing audit reviews to determine if correct payments were made to providers.  Responsibilities:   Perform an extensive review of client accounts to determine if correct payment were made to providers. Accurately reprice complex claims utilizing client claim systems. Identify work file to be audited through a query process. Review provider contracts/fee schedules to determine payment methodology. Documentation of audit findings to be shared with client. Evaluate current procedures for efficiency and accuracy.  Recommend solutions for process improvements.  Performed other duties as assigned. Conduct all job functions and responsibilities in accordance with all company Compliance,  Information Security and Regulatory policies, procedures and programs.    Qualifications: 5-7 years of Medical Claims Processing/Pricing Experience with a background in Payment Integrity Audits a plus.    Knowledge of CMS Pricing Guidelines and Coding Methodologies Strong analytical skills, with attention to details Excellent oral and written communication skills Strong skillset in Excel, Database Knowledge, and Word Education and Required Certification:   High School Diploma

Salary : $65,000 - $95,000