Payment Integrity Data Mining Consultant I

Sagility is a company that combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise. A Payment Integrity Data Mining Consultant I is responsible for identifying new audit opportunities, researching new pricing methodologies, and engaging with various work teams to generate systems automation and enhancement capabilities in our state-of-the-art audit workstation.

Requirements

• High School Diploma or equivalent required
• BA/BS in Business Administration or related field or equivalent preferred but not necessary
• 4-5+ year's knowledge of direct claim processing/reimbursement, medical facility contracts, fee schedules, inpatient/outpatient/physician claims required
• Prior claims auditing or consulting experience desirable in either a provider or payer environment
• Excellent communication skills both oral and written
• Strong interpersonal skills that will support collaborative teamwork
• Microsoft Office Proficient: Word and Excel; Access – highly preferred