Data Mining Auditor

Machinify

. Conduct comprehensive reviews of pre and post pay claims using claims data, client adjudication systems, payment guidelines, regulatory requirements, contracts, pricing systems, medical records, authorizations, and other available resources.

Posted 11/1/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims billing and payment processes, with a strong focus on compliance with Medicare and payer billing guidelines. Proficient in data analysis and policy development to ensure high-quality claim identification and documentation.

Highest-signal resume keywords

Claims Billing ExpertiseMedicare Billing GuidelinesData AnalysisAttention To DetailProblem-Solving Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Data ReviewReimbursement Policy DevelopmentCoding/Billing CertificationData Mining AuditingPayment Guidelines Analysis

Soft Skills

Investigative SkillsDeductive ReasoningDeadline ManagementAdaptabilityCollaboration

Tools & Technologies

ExcelWordGmailGoogle SheetsSlack

Industry Keywords

Pre-Pay AuditingPost-Pay AuditingPayer AuditingRegulatory RequirementsQuality Assurance

About the role

Key responsibilities & impact

Conduct comprehensive reviews of pre and post pay claims using claims data, client adjudication systems, payment guidelines, regulatory requirements, contracts, pricing systems, medical records, authorizations, and other available resources.
Serve as a claims billing and payment expert and resource for data teams and other departments.
Develop and refine reimbursement policies and procedures in collaboration with the team.
Remain updated with the latest billing guidelines and regulations.
Achieve expected accuracy and quality levels for valid claim identification and documentation.
Perform additional responsibilities as assigned or needed to support the business.

Requirements

What you’ll need

3-5 years of relative experience.
Ability to review payment information against Medicare and payer billing guidelines to make determinations relating to the appropriateness of payments.
Experience or certification in coding/billing is helpful.
Ability to meet deadlines.
Willingness and ability to do whatever is necessary to accomplish workload demands
Delivery of high-quality work is critical.
Strong attention to detail; investigative and deductive reasoning skills are a must.
Must be able to make decisions and conclusions when working with limited information using reference materials and strong problem-solving skills.
Must be proficient in Excel, Word, Gmail, Google Sheets, Slack, etc.
Able to work in a fast-paced environment and adapt to rapid change and growth.
Preferred: Post-Pay data mining auditing experience.
Preferred: Pre-Pay data mining experience.
Preferred: Payer auditing experience.

Benefits

Comp & perks

Work from anywhere in the US! Machinify is digital-first.
Top Medical/Dental/Vision offerings
FSA/HSA
Tuition reimbursement
Competitive salary
401(k) with company match
Additional health and wellness benefits and perks
Flexible and trusting environment where you’ll feel empowered to do your best work