Manager, Data Mining (Payment Integrity)

Quick Facts

• Role: Manager, Data Mining (Payment Integrity)

• Focus: Payment integrity savings and recovery through post-payment data mining audits

• Work setup: Tempe, Arizona office with a hybrid schedule (3 days in office per week; Thursdays required)

Description

The Manager of Data Mining leads a team of individual contributors to ensure payment integrity data mining audits and vendor oversight meet savings and recovery targets. You will manage quality control for vendor submissions, build consistent team workflows, and partner with technology/data science teams on algorithms to identify savings and recovery opportunities.

Responsibilities

• Oversee the quality control process for data mining vendor submissions, ensuring accuracy and alignment with program standards

• Lead daily operations of the data mining team, including strategic delegation of work to internal auditors and external partners

• Develop team workflows and guidelines that produce consistent and measurable outcomes

• Train, teach, and mentor team members

• Partner with technology and/or data science teams to establish algorithms for savings and recovery identification

• Ensure compliance with all applicable laws and regulations

• Other duties as assigned

Requirements

• Bachelor’s degree or 4+ years of commensurate experience

• 4+ years of experience in healthcare operations

• 2+ years of experience leading and developing a team

• 2+ years of experience designing, implementing, and improving business workflows

Bonus Points

• 2+ years of payment integrity experience at a health plan or vendor organization

• Experience with healthcare claims adjudication

• Experience with SQL and basic SQL abilities

• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)

Benefits

• Base pay: $100,602–$132,040 per year

• Employee benefits including medical, dental, and vision

• Unlimited vacation program and annual performance bonuses

• 401(k) participation, paid holidays and paid sick time, paid parental leave, life and disability insurance, and paid wellness time and reimbursements