Data Mining Ideation Specialist (Medtech)

TL;DR

Data Mining Ideation Specialist (Medtech): Designing and developing data mining audits to ensure payment accuracy across Medicaid, Medicare, and Commercial lines of business with an accent on translating complex reimbursement policies into actionable audit concepts. Focus on identifying improper payments, building scalable audit logic, and validating data selection parameters.

Location: Remote (Must be based in the USA)

Salary: $80,000–$100,000

Company

hirify.global is a payment integrity firm specializing in medical coding and reimbursement audits to drive payment accuracy for healthcare payers.

What you will do

• Identify data mining audit opportunities based on Federal, State, Local, and Client-specific regulations and policies.
• Define data selection requirements and validate outputs to ensure high precision in overpayment identification.
• Develop concept-specific training materials and provide guidance to production audit teams.
• Monitor audit performance, yield, and appeal outcomes to continuously refine audit logic.
• Partner with analytics and operations teams to move audit concepts from ideation to production implementation.

Requirements

• 5+ years of complex claims processing and/or coding auditing experience in the health insurance industry.
• Current Coding Certification: AAPC (CPC, COC) or AHIMA (CCS) or RHIT designation.
• Mastery of CPT, HCPCS, and ICD-10 coding standards and their impact on claim payments.
• Expert understanding of US reimbursement methodologies, including CMS policies, NCDs, LCDs, and NCCI Edits.
• Expertise in data analysis and advanced Excel.
• Deep knowledge of US healthcare payer types: Medicare, Medicaid, and Commercial plans.

Nice to have

• Python or SQL coding skills.
• Clinical background or experience.
• Exposure to EDI transactions (837, 835).
• Experience using coding tools such as 3M, Webstrat, or Encoder.

Culture & Benefits

• Fully remote work arrangement.
• Role at the intersection of medical coding, data analytics, and audit development.
• Opportunity to drive significant financial impact through high-impact audit concepts.
• Collaborative cross-functional environment working with audit, analytics, and operations teams.