Clinical Data Analyst & Auditing Specialist

India - Hyderabad

Company Overview:

ZignaAI is focused on delivering innovative solutions that transform healthcare payment operational processes. We empower payers, providers, and patients with AI-powered software solutions that drive transparency in healthcare payment services.  Built-in intelligence-enabled machine learning algorithms deliver pre-billing payment accuracy solutions and avoid provider abrasion. We differ from traditional payment services solutions by resolving issues at the root by ensuring accurate payments, automating processes, with nudges delivered to billing coders. Our innovative and scalable solutions cover Medicaid, Medicare, and Commercial policies and deliver results in weeks.

Opportunity Overview:

This is a great opportunity for an aspiring clinical data analyst to join a healthcare analytics company and deliver meaningful outcomes that reduce the cost of care. Candidates will work closely with data science leadership, operations, and engineering to build intelligence in the system. This will involve constant learning and application to solve business problems. This position will require the candidate to be an out-of-the-box thinker, intellectually curious, and with great attention to detail. This role offers the potential to grow at Zigna in data science and gain strong domain knowledge. We are committed to developing and nurturing talent at ZignaAI.

Minimum Qualifications:

We are a startup and expect each team member to wear multiple hats, take initiative, and spot and solve problems.

Our organization is seeking a detail-oriented Clinical Data Analyst & Auditing Specialist. This role primarily focuses on analyzing health data, performing ICD-10-CM, ICD-10-PCS, CPT, and HCPCS audits, as well as assisting in the training of an AI system for coding and auditing healthcare claims. The ideal candidate will hold a coding credential from AHIMA or AAPC, have completed coursework in medical terminology, anatomy, and physiology, and have extensive experience in DRG and/or APC audits, with a deep understanding of coding guidelines, payor guidelines, and contracts. 

  • Analyze healthcare-related data to inform the training of AI systems and contribute to system improvements. 
  • Perform comprehensive audits using ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes. 
  • Assist in the training and refinement of AI models to improve their coding and auditing accuracy and efficiency. 
  • Collaborate with the analytics team, providing feedback to optimize data systems and train the AI models. 
  • Ensure compliance with healthcare regulations and maintain awareness of industry changes. 
  • Generate and present detailed reports on audit findings, recommendations, and data analysis outcomes.


Preferred:

  • Experience with AI programming, particularly in machine learning and deep learning models, is a plus. 
  • Active coding credential from AHIMA or AAPC (RHIA, RHIT, CCS, CCS-P, CIC, COC, CPC). A degree in a healthcare-related field is a plus. 
  • Minimum of 5 years of experience conducting DRG and/or APC audits. 
  • In-depth knowledge of coding guidelines, payor guidelines, and contracts. 
  • Proven ability in managing time and prioritizing work effectively. 
  • Excellent written and verbal communication skills. 
  • Familiarity with healthcare data analytics and data analysis tools. 
  • This role presents an opportunity to apply and expand your expertise in healthcare data analysis, coding and auditing, and AI training. If you are a diligent professional passionate about improving healthcare through data, we encourage you to apply. 

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We are here to drive a transparent reimbursement process to deliver excellent care at the right cost

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