Payment Accuracy and Concept Lead (AI-Driven)

Team8 Inc; United States; On-site; USD 80,000 - 120,000; Full time

Job summary

A health-IT startup is seeking a Payment Accuracy and Concept Lead to identify medical billing errors and fraudulent claims. The ideal candidate will leverage the company's platform to create and refine audit concepts in collaboration with Medical Coders and Engineering teams. This position requires extensive knowledge of medical terminology and experience in the healthcare sector. A Registered Nurse is preferred, along with a Bachelor's or Graduate degree. Competitive compensation and remote work options are offered.

Qualifications

• Extensive knowledge of medical records and health information management.
• Previous auditing or consulting experience is preferred.
• Knowledge of claims adjudication processes and provider billing systems.

Responsibilities

• Develops and refinements of new audit concepts in healthcare.
• Collaborates with Medical Coders and Engineering teams.
• Leads in-depth research of new ideas and concepts.

Skills

Extensive knowledge of medical terminology

Experience in medical coding

Strong research skills

Education

Registered Nurse

Bachelor's or Graduate degree

Job description

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

Bluespine - 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