AI Data Engineer – Denial Prediction

Job description

Job Title: AI Data Engineer – Denial Prediction

Experience: 4–9 Years

Company: TalentGigs

Domain: Healthcare / Revenue Cycle Management (RCM)

Location: Chennai

Role Overview

We are looking for an experienced AI Data Engineer with strong expertise in Healthcare RCM and Denial Prediction systems. The ideal candidate will work on building scalable data pipelines and AI-driven solutions to predi...ct, prevent, and explain claim denials across the revenue cycle.

Key Responsibilities

• Design and build AI-powered denial prediction systems using healthcare data

• Develop and maintain ETL pipelines for large-scale claims data processing

• Work with structured datasets like:

• X12 (837/835)

• HL7 / FHIR

• EHR data

• Build and deploy machine learning models (classification, risk scoring, anomaly detection)

• Implement feature engineering pipelines for denial prediction use cases

• Develop real-time and batch data pipelines using PySpark / Databricks

• Integrate prediction models into:

• Claim scrubbing systems

• Billing workflows

• RCM platforms

• Build feedback loops using remittance data (835) to improve model accuracy

• Ensure data quality, governance, and HIPAA compliance

• Work closely with business stakeholders, SMEs, and product teams

Required Skills

Technical Skills

• Strong programming: Python, SQL

• Big Data: PySpark, Spark, Databricks

• Cloud Platforms: AWS / Azure / GCP

• ETL Tools: Airflow / ADF / Glue / DBT

• Data Warehousing: Snowflake / Redshift / BigQuery

• Data Modeling & Pipeline Design

AI / ML Skills

• Experience with:

• Classification models

• Anomaly detection

• Predictive analytics

• Knowledge of:

• Feature engineering

• Model evaluation

• Experience in Explainable AI (SHAP, feature importance) is a plus

Domain Expertise (Mandatory / Strong Preferred)

• Healthcare Revenue Cycle Management (RCM)

• Claims processing & denial management

• Understanding of:

• CPT / ICD / HCC coding

• Medical necessity

• Prior authorization

• Familiarity with payer rules & claim validation logic

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