Senior Data Analyst - Payer Side - CMS, NCCI
Optum (company site, opens in a new tab)8+ yrsNoidaOn-siteDirect career pageEst. 18–30 LPA
Posted on 14 Sept
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Job description
Structured overview of role & requirements
About This Role
- Lead clinical evaluation and in-depth review of US healthcare claims to detect fraud, waste, and abuse using coding and reimbursement policy expertise.
- Drive clinical validation strategies and translate complex CMS, NCCI, and payer policies into actionable payment integrity insights with measurable impact on rule accuracy and provider relations.
- Mentor junior analysts and collaborate with analytics teams to ensure clinical accuracy in data models and support strategic enhancements in payment integrity programs.
Minimum Requirements
- Undergraduate degree or equivalent experience.
- Minimum 8 years of experience in US healthcare payment integrity, coding, or clinical claims review.
- Expert-level knowledge of CPT, HCPCS, ICD-10-CM, DRG, modifiers, and complex billing practices.
- Extensive experience interpreting CMS manuals, NCCI policies, LCD/NCD, and payer guidelines in specialties such as surgery, inpatient DRG, and E/M.
Ideal Candidate Profile
- Experienced in leading or significantly contributing to payment integrity or large-scale fraud, waste, and abuse programs in the US healthcare payer domain.
- Demonstrates advanced clinical subject matter expertise with capacity to develop clinical strategies and rules impacting payment integrity at scale.
- Effective communicator comfortable with leadership/stakeholder engagement and mentoring analytic teams within complex healthcare environments.