Manager of Data Mining Job in Jacksonville, Florida

SCIO Health Analytics/EXL Company is looking for an experienced Manager of Data Mining. This is a Home Office opportunity. The Manager of Data Mining is responsible for oversight of the day-to-day functions of the assigned program. This includes but is not limited to supervision of employees, training, quality assurance, and management of new concepts.

KEY DUTIES AND RESPONSIBILITIES:

• Direct and manage the data mining process from beginning to end.
• Answer questions from Auditors, Analyst, Senior Analyst, and Quality Analyst.
• Ensure Auditors and Quality Auditors are meeting production and quality expectations.
• Assist with new query development.
• Ability to present program updates and issues to clients and internal management in a professional manner.
• Work with clients on questions or requests that would impact identifications of overpayments.
• Mentor assigned staff and when necessary conduct disciplinary action.
• Ensure adjustments are made to queries based on client disputes/feedback.
• Ensure Audit Coordinators are performing tasks in a timely manner.
• Work with team to ensure project priorities and timelines are met.
• Update department reports defined by Management.
• Ensure assigned staff has all the necessary tools in order to perform job.
• Work with team to ensure project priorities and timelines are met.
• Update department reports defined by Management.
• Ensure assigned staff has all the necessary tools in order to perform job.
• Manage/Assist training of new assigned staff.
• Handle responsibilities of assigned staff that are not performed/covered.
• Understands claim processing for assigned clients.
• Will perform other duties as assigned

SUPERVISORY RESPONSIBILITIES:

Will supervise: Auditor, Analyst, Senior Analyst, Quality Auditor

QUALIFICATIONS:

• College Degree or Equivalent Work Experience
• 3-5 Years Experience with Medical Claims Processing 
• 2-5 Years Experience with various types of Medical Health Care Claims Processing including but not limited to: Types of Claims: (DRG, Skilled Nursing, Home Health, Durable Medical Equipment) and Payment Structures (DRG, Per Diem, RUG, OASIS, Fee Schedule)

KNOWLEDGE AND SKILLS:

• Attention to Detail
• Proven problem-solving abilities
• Excellent written and oral communication skills
• Effective Time Management Skills
• Highly self-motivated and directed
• Flexible during times of change - Adjust to shifting priorities and timelines through analytical and problem solving capabilities
• Must be able to learn, understand, and apply new technologies
• Professional Communication
• Ability to travel to client locations as business needs dictate