[Remote] Healthcare Data Analyst \/ Algorithm Developer

Note: The job is a remote job and is open to candidates in USA. RADcube is seeking a detail-oriented Healthcare Data Analyst / Algorithm Developer to support healthcare data analysis and program integrity activities. This role involves analyzing claims and encounter data, developing data-driven algorithms, and producing insights to aid clinical and operational decision-making. Responsibilities • Analyze healthcare claims, encounter, provider, and medical record-related data to identify trends, anomalies, outliers, and potential coding or billing compliance risks • Develop, test, validate, and maintain algorithms, business rules, and SQL queries used to support coding reviews, audit targeting, payment integrity, and compliance monitoring activities • Translate coding, reimbursement, and policy requirements into data logic that can be used to flag records, claims, or providers for further review • Support development of analytical models and rule sets related to CPT, HCPCS, ICD-10, modifiers, place of service, units, and other claims elements • Review data outputs for accuracy, reasonableness, and alignment with review objectives, audit scopes, and program policies • Partner with coders, auditors, clinicians, and compliance staff to understand review requirements and convert those requirements into repeatable analytic approaches • Identify patterns related to documentation deficiencies, claim errors, utilization anomalies, denial trends, overpayment risks, and potential fraud, waste, and abuse indicators • Prepare data files, summaries, scorecards, dashboards, and reports for internal stakeholders, audit teams, and program leadership • Support record selection methodologies for audits, sampling, monitoring, and focused reviews using claims and related data • Perform data validation, quality checks, reconciliation activities, and root cause analysis to ensure reliability of analytic outputs • Document query logic, technical methods, assumptions, and validation steps in a clear and reproducible manner • Assist with ad hoc analysis related to coding accuracy, reimbursement trends, provider billing patterns, and policy changes • Support maintenance of reference tables, edit logic, provider attributes, coding crosswalks, and other data assets used in analytics • Monitor impacts of coding and regulatory updates on data logic, algorithms, and analytic reporting • Collaborate with internal stakeholders to improve audit efficiency, targeting precision, and reporting clarity • Adapt quickly to changing priorities, evolving business rules, and new review requirements while meeting deadlines and maintaining quality Skills • Bachelor's degree in data analytics, health information management, informatics, public health, healthcare administration, statistics, computer science, or a related field preferred • At least 2 years of experience in healthcare data analysis, claims analysis, payment integrity, program integrity, revenue cycle analytics, or related work preferred • Strong experience with SQL required, including writing complex queries, joining large datasets, aggregating results, and validating outputs • Experience working with healthcare claims or encounter data required; Medicaid experience strongly preferred • Proficiency in Microsoft Excel required; experience with data visualization and reporting tools preferred • Strong analytical, critical thinking, problem-solving, and organizational skills • Ability to communicate technical findings clearly to non-technical audiences • Strong attention to detail and ability to manage multiple datasets, priorities, and deadlines • Ability to work independently and collaboratively in a fast-paced environment • Working knowledge of medical coding concepts, including CPT, HCPCS, and ICD-10, strongly preferred • Familiarity with healthcare billing, reimbursement, documentation review, audit support, or compliance monitoring preferred • Experience developing logic models, analytic rules, dashboards, or automated reporting solutions preferred • Ability to translate complex healthcare policy and coding requirements into clear analytic logic • Strong understanding of claims structures, provider billing behavior, and reimbursement data relationships • Experience identifying outliers, trend shifts, and risk indicators through targeted data analysis • Ability to prepare concise, decision-ready summaries of findings for operational and leadership audiences • Comfort working in an environment that combines data analytics, coding review, audit support, and compliance monitoring • Experience supporting initiatives related to payment integrity, fraud waste and abuse detection, utilization review, or billing compliance is strongly preferred Company Overview • RADcube, with its inception in 2016, stands tall as a pioneer in the software solutions industry, boasting of nearly a decade of rich experience. It was founded in 2015, and is headquartered in Carmel, Indiana, USA, with a workforce of 201-500 employees. Its website is http://www.radcube.com/. Company H1B Sponsorship • RADcube has a track record of offering H1B sponsorships, with 8 in 2025, 9 in 2024, 4 in 2023, 2 in 2022, 9 in 2021, 2 in 2020. Please note that this does not guarantee sponsorship for this specific role.