Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse.  Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a-service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques.

 

We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry. 


Position Summary: 

As a Business/Data Analyst at Codoxo, you will be instrumental in managing the data health within our platform. You will leverage your extensive knowledge of healthcare claims, provider, and member data, along with your expertise in medical codes and healthcare operations, to create, maintain, map, and manage healthcare claim data. Additionally, you will be responsible for validating claims data, creating customer-facing reports, and maintaining data mappings to ensure data accuracy and integrity.

 

Key Responsibilities:

  • Healthcare Data & Claims Expertise:
    • Possess a strong understanding of healthcare claims, provider, and member data.
    • Exhibit a strong knowledge and understanding of the various fields included on professional, facility, pharmacy, and dental claims data.
    • Demonstrate a solid understanding of relationships within healthcare claims data.
    • Demonstrate proficiency in medical codes, including ICD-10, CPT, HCPCS, DRG, etc.
    • Demonstrate expertise in both pre- and post-adjudicated claims data.
    • Understand claim adjustment logic and its application.
  • Data Health Management:
    • Play a crucial role in maintaining the data health of our platform.
    • Ensure the accuracy, consistency, and integrity of healthcare claims, provider, and member data.
  • Data Validation:
    • Analyze data supplied by the customer to identify potential data gaps and nuances.
    • Assess data to ensure it aligns with defined standards and formats required by platform.
    • Validate claims data within our platform after ingestion to ensure accuracy and reliability.
  • Healthcare Industry Experience:
    • Have previous experience working in a healthcare organization, understanding the complexities of the industry.
    • Have previous experience working with and analyzing healthcare claims data.
  • Data Management:
    • Utilize hands-on experience to create, maintain, map, and manage healthcare claim data effectively.
    • Maintain data mappings and update them to reflect changes in data or systems.
    • Assist with documenting data transformation rules to ensure accurate ingestion into the platform.
    • Identify and utilize external data sources to enrich healthcare claim data, enhancing its completeness and relevance.
  • Technical Skills:
    • Advanced knowledge of Microsoft Office Suite, including Excel and other Office 365 productivity tools.
    • SQL experience required. Python experience preferred.
  • Report Generation & Documentation:
    • Create customer-facing external reports based on data health insights to provide value to our clients.
    • Document identified data gaps and issues for internal consumption and communication to the customer.
  • Communication:
    • Provide regular status updates to both internal and external stakeholders.
    • Clearly communicate data gaps and issues to customers.
    • Lead data discussions and provide subject matter expertise on potential solutions.

 

 

Qualifications:

  • Bachelor's degree in a related field (e.g., Healthcare Management, Business, Data Science).
  • Proven experience as a Business/Data Analyst in a healthcare setting.
  • Strong knowledge of healthcare claims, provider, and member data.
  • Understanding of professional, facility, pharmacy and dental claims processing.
  • Proficiency in medical coding systems (ICD-10, CPT, HCPCS).
  • Previous experience with healthcare data management and mapping.
  • Advanced skills in Microsoft Excel and Office 365.
  • SaaS application knowledge will be a plus.
  • Experience with SQL required. Python experience preferred. 
  • Excellent analytical and problem-solving abilities.
  • Effective communication and presentation skills.
  • Detail-oriented and committed to data accuracy.
  • Ability to adapt to changing data environments and industry regulations.
  • Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk. 

 

 

Accessibility Notice: If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send an email to careers@codoxo.com with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case basis.

 

Benefits for You

Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)

Unlimited PTO

Annual Professional Development stipend

Annual home office stipend

401K Match (after 90 days)

 

We are an Equal Opportunity Employer:

Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.  This policy applies to all terms and conditions of employment.