7 days old

Healthcare Data Mining BI Program Lead - Commercial Audit

Sunrise, FL 33351
Regular Full Time

Healthcare Data Mining BI Program Lead Commercial Audit
Leverages subject matter expertise, strong analysis skills and data modeling in applying market intelligence to large volumes of client healthcare claim audit data to identify unique and emerging trends and patterns or data outliers that lead to meaningful new overpayment recovery opportunities and strategies for our commercial healthcare audit clients, and business revenue. 

Lead focus area/program proof of concept development in collaboration with functional leadership
Develop program methodology and infrastructure 
Consistently meet and exceed revenue goals and business objectives
Contribute to development of tools, workflow, documentation
Applies depth and breadth of diverse skills and subject matter expertise to identify meaningful new overpayment recovery opportunities and strategies
Conducts complex analysis using large volumes of data identifying unique and emerging trends, patterns, and data outliers. 
Read and analyze provider contract agreements and hospital-level profile analysis
Evaluates and quantifies potential new meaningful recovery opportunities; prepares financial analysis of findings
Distills complex data into clearly articulated strategies and opportunities to present to leadership 
Uses excellent communication skills to influence a wide range of internal and external audiences
Develops requirements for new production queries for new audit opportunities and collaborates with analytic engineering team for development
Define script requirements for new recovery opportunity concepts and develop controls for concept recovery processes
Support existing concept optimization and surface data issues to analytic team
May develop, coach, and lead other analysts; contribute to hiring and building team 
Leads and contributes to ad-hoc projects and initiatives
Other duties as assigned

*Note - All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times.  Violations to Performants policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.


Required Skills and Knowledge:
Skills and Experience
Extensive relevant knowledge of healthcare systems, hospitals, and contractual arrangements; as well as reimbursement methodologies, itemized bill review, and high cost drugs and formularies. 
Excellent data manipulation and presentation skills using Excel
Expert level analytical skills blending data trends with market, industry, client, and subject matter expertise
Ability to communicate and collaborate with payment integrity leaders both internally and externally at clients and hospitals
Documentation and/or development of supporting deliverables to justify exploratory revenue opportunities 
Demonstrated ability to consistently identify, develop, and drive new meaningful revenue opportunities for claim overpayment recovery in commercial healthcare audit,
Solid working knowledge of database applications, including extraction and querying skills.  Demonstrated ability to develop high quality scripting requirements for database team.
Proficient using SQL and MS Access 
Quickly learns and adapts to internal database tools (IDS) 
Strong critical thinking and problem-solving skills 
Demonstrated program and project management skills
Self-motivated and thrives in a fast-paced business
Ability to obtain and maintain client required clearances, if applicable, as well as pass company regular background and/or drug screening.
Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.

Physical Requirements:
Job is in a busy standard  is performed in an office environment with moderate noise level (or may be home-office setting subject to Company approval and Teleworker Agreement), sits at a desk during scheduled shift, uses office phone or headset provided by the Company for calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a mouse.
Reads and comprehends information in electronic (computer) or paper form (written/printed). 
Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment.
Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts.
Consistently communicates on the phone as required primarily within the department and company and may include client contacts or other third-party depending on assignment with account holders, may dial manually when need or use dialer system; headset is also provided.
Occasionally lift/carry/push/pull up to 10lbs.


Education and Experience:
Education and Experience
Bachelors degree in relevant field or equivalent combination of education and experience.
5+ years relevant professional level experience with increasing responsibility relevant to the position demonstrating subject matter expertise relevant to commercial healthcare payer claims audit.
5+ years demonstrated successful track record of complex data mining and business intelligence resulting in high volumes of unique/non-standard recoveries for clients
2+ years in relevant leadership role(s). 
Experience building and driving programs and projects in a similar business

Other Requirements

Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.
Must submit to and pass pre-hire background check, as well as additional checks throughout employment.
Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.
Must submit to and pass drug screen pre-employment (and throughout employment).
Performant is a government contractor. Certain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the Company.

Visa sponsorship is not available.

Job Profile is subject to change at any time.


Performant Financial Corporation is an Equal Opportunity Employer.

Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. 



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Posted: 2021-01-08 Expires: 2021-02-14
Analytics, audit, and recovery services for healthcare, government and student loans.

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Healthcare Data Mining BI Program Lead - Commercial Audit

Performant Financial
Sunrise, FL 33351

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