Bluespine-Payment Accuracy and Concept Lead (AI-Driven)

your Jared; Northern (KY); Hybrid; USD 120,000 - 210,000; Full time

Benefits offered by this job

Registered Nurse required; Bachelor’s/

Previous auditing or consulting with  

Job summary

Bluespine is seeking a Payment Accuracy and Concept Lead to identify medical billing errors and fraudulent patterns for commercial payers. You will lead concept development across audit verticals, collaborating with Medical Coders, Data Sciences, and Engineering to ensure alignment and high-impact results.

The role requires extensive knowledge of medical terminology, coding guidelines, DRG methodologies, and claims adjudication processes.

Qualifications

• Extensive knowledge of medical terminology, medical records, health information management, medical coding, DRG methodologies, CPT/HCPCS coding guidelines, physician specialty guidelines, reimbursement programs, claims adjudication processes, member contract benefits, and provider billing systems and practices.
• Previous auditing or consulting experience in a provider or payer environment is preferred

Responsibilities

• Leverages the Bluespine platform to develop and refine new audit concepts in healthcare. Leads concept creation across multiple audit verticals.
• Works closely with Medical Coders, Data Sciences, and Engineering teams to ensure alignment and drive impactful results
• Lead in-depth research of new ideas and concepts

Skills

Medical terminology

Medical coding

DRG methodologies

CPT/HCPCS guidelines

Health information management

Claims adjudication

Education

Registered Nurse (RN)

Bachelor’s or Graduate degree

Job description

Bluespine-Payment Accuracy and Concept Lead (AI-Driven)

Location: Remote, US Remote

Description

Bluespine is an innovative new startup in the health-IT domain. By employing cutting-edge technologies, Bluespine is developing an engine that detects errors in medical billing, which causes billions of dollars in losses across the entire industry. Bluespine can offer personalized precision by tailoring assessments to each unique medical claim, considering the relevant provider, payer, and plan, and ensuring unparalleled accuracy.

We are looking for a Payment Accuracy and Concept Lead to discover medical billing errors and fraudulent billing patterns of medical claims for commercial payers.

Utilized Bluespine platform to develop and enhance new audit concepts using healthcare. Leads concept creation across multiple audit verticals, collaborating with R&D for testing

Responsibilities

• Leverages the Bluespine platform to develop and refine new audit concepts in healthcare. Leads concept creation across multiple audit verticals.
• Works closely with Medical Coders, Data Sciences, and Engineering teams to ensure alignment and drive impactful results
• Lead in-depth research of new ideas and concepts

Requirements:

• Extensive knowledge of medical terminology, medical records, health information management, medical coding, DRG methodologies, CPT/HCPCS coding guidelines, physician specialty guidelines, reimbursement programs, claims adjudication processes, member contract benefits, and provider billing systems and practices.
• Previous auditing or consulting experience in a provider or payer environment is preferred

Advantages

• Registered Nurse required; Bachelor’s or Graduate degree
• Previous auditing or consulting experience with self-insured companies