The Medical Review Clinical Appeals Auditor conducts appeals reviews of medical audit findings and documents results based on new evidence. They also serve as a subject matter expert, providing escalation support and contributing to training and process improvement initiatives.
The Coding Validation Specialist reviews provider medical records to validate the accuracy of behavioral health and substance use disorder claims. They analyze claim information, resolve coding issues, and ensure compliance with regulatory and client-specific policies.
You will architect and build scalable backend systems while integrating AI coding agents into the development workflow. You will also collaborate cross-functionally to influence product direction and mentor team members on engineering standards.
The manager will oversee the Itemized Bill Review team's daily operations, ensuring all SLAs are met and performance metrics are tracked. They will also collaborate across departments to drive process improvements and manage client communications.
The Manager will oversee the Complex Clinical Bill Review team, managing production expectations, SLAs, and team performance. They will also coordinate system enhancements, develop training materials, and act as a liaison between operations and client success teams.
You will design and implement robust, production-grade data pipelines to transform raw healthcare data into trusted, queryable datasets. Additionally, you will collaborate with cross-functional teams to onboard new customers and ensure the reliability and performance of core ML and product data workflows.
The supervisor manages a remote team of nurses and audit staff to perform clinical review audits while ensuring productivity and quality standards are met. They also contribute to strategy activities, including capacity planning, needs assessments, and the implementation of new audit concepts.
The Training Specialist will design, develop, and deliver comprehensive training programs for clinical audit staff focusing on IPF and IRF claims. They will also serve as a clinical subject matter expert, analyzing performance data to drive continuous improvement in audit accuracy and quality outcomes.
You will own the end-to-end technical and operational lifecycle of client migrations, from legacy system analysis to production deployment. This involves orchestrating cross-functional collaboration and building scalable, automated migration pipelines.
You will set the technical direction for backend systems and design scalable, cloud-native services to support payment-integrity decisions. You will also mentor engineers, collaborate cross-functionally, and own your services in production to ensure reliability and performance.
The Medical Review Nurse performs retrospective and prepayment medical claims audits for government clients while applying appropriate medical review guidelines. They also document findings, generate audit letters, and support findings during the appeals process.
The Medical Review Nurse II performs retrospective and prepayment audits on skilled nursing facility claims to ensure medical appropriateness and compliance. They also document findings, generate audit letters, and support the appeals process while collaborating with clients and internal teams.
You will set the technical direction for backend development and design scalable, reliable web application systems while collaborating with AI coding agents. You will also act as a developer coach, setting standards and mentoring team members to elevate overall programming maturity.
The Director of Quality Assurance Engineering will define the quality strategy and organizational design across the full software development lifecycle. They will lead a high-performing team to implement AI-driven technical quality architectures and establish rigorous release standards.
Collaborate with clients and internal stakeholders to integrate analytical outputs with payment integrity requirements and claims adjudication systems. Drive AI adoption by developing automated workflows and maintaining complex SQL queries against large-scale healthcare datasets.
Lead the development, testing, and optimization of payment integrity audit concepts across government and commercial healthcare claims. Collaborate with cross-functional teams to ensure audit concepts align with coding standards, regulatory requirements, and payer policies.
The role involves scaling inherited Scala systems, redesigning the data layer for AI products, and building a Rust framework for performant services. Additionally, the engineer will drive AI tool adoption and improve platform observability and resilience.
Perform medical claims audit reviews specifically for the Home Health sector for government and commercial payers. Document findings based on medical review guidelines and support these findings during the appeals process.
Oversee quality assurance for DRG Reviewers to ensure adherence to clinical and coding standards. Conduct training sessions for new and existing staff to enhance skills and maintain compliance.
The Claims Administrator supports efficient claims processing by reviewing incoming claims, organizing data, and routing files to auditors. They are also responsible for managing import queues, reconciling balances, and monitoring data transfer accuracy.
Provide legal support and guidance to subrogation recovery teams and the General Counsel. Ensure adverse suits are handled appropriately and train analysts on relevant legal statutes and regulations.
Lead the engineering team in building a scalable, AI-driven cloud-native solution for Coordination of Benefits (COB). Own the technical roadmap, architecture, and production releases while managing and coaching a team of 5-6 engineers.
Lead the transformation of pharmacy payment integrity from manual workflows to AI-first automation, owning the roadmap for AI agents and voice AI. Design automated payment recovery workflows and redesign customer-facing analytics portals to demonstrate ROI.
Perform secondary reviews of outpatient coding validation audits to ensure accuracy, consistency, and compliance with regulatory standards. Monitor auditor performance, provide coaching, and develop quality assurance tools to improve operational excellence.
Lead and grow the AI/ML Engineering team to design, deliver, and operate a scalable core AI/ML platform. Partner with the Chief AI Officer to bridge the gap between data science proof-of-concepts and production-grade services.
Extract hidden patterns and insights from large healthcare datasets to drive business strategy and operational efficiency. Lead small data projects and create comprehensive reports and visualizations to communicate results to diverse audiences.
Design and build scalable, reliable full-stack web applications that apply ML techniques to large volumes of data. Balance the development of new customer-facing features with technical debt cleanup to ensure software sustainability.
Own end-to-end data science workflows to build and productionize ML and LLM-powered solutions for healthcare payment intelligence. Lead high-impact initiatives and set technical direction through mentorship and design reviews to improve business outcomes.
Develop and refine product messaging, positioning, and value propositions to translate complex AI capabilities into clear narratives for healthcare payers. Support the creation of sales enablement tools, video content, and the coordination of product launches.
You will own the end-to-end product lifecycle for the Coordination of Benefits (COB) line, including strategy, roadmap, and execution. You will drive the vision for AI-native workflows to improve claims recovery and operational efficiency.
Conduct comprehensive outpatient payment validation reviews to ensure accurate coding, billing, and compliance with payer policies. Document audit findings and provide well-supported rationales for reimbursement impacts using industry-standard references.
The analyst will review facility insurance claims and itemized statements to ensure the accuracy of charges against medical documentation and compliance guidelines. They will also collaborate with internal teams to improve claim review efficiency and assist in content development and research.
The Software Architect will own the design and implementation of the intelligent document processing and agentic evaluation framework. This role involves hands-on technical leadership, defining system abstractions, and ensuring the platform scales to process healthcare documents at a high volume.
The Senior Director will lead end-to-end business development across federal and state government markets, focusing on Medicaid and federal health agencies. They will manage the full sales cycle, including RFP responses, strategic partnerships, and policy-driven market positioning.
You will drive the data product roadmap by partnering with engineering and architecture leadership to translate business needs into technical requirements. The role involves coordinating the consolidation of legacy systems into a unified AI-powered platform while enabling new product capabilities across the healthcare payment continuum.
Develop and advance machine learning models to optimize healthcare claim audits and improve financial outcomes. Create technical frameworks and data pipelines to enhance team efficiency and model precision.
The role involves conducting thorough DRG payment validation reviews, including clinical and coding assessments of medical records to ensure accurate payment determinations based on contract-specific criteria. Key duties include meticulously documenting findings, providing clinical and policy support, and collaborating with stakeholders to maintain compliance with payment standards.
The Data Scientist will translate complex medical policies and clinical criteria into executable SQL and Python code, focusing on building robust clinical feature pipelines from extracted signals in medical records. They will also own the measurement, evaluation, and continuous quality improvement of the AI system responsible for extracting structured clinical information.
This role is responsible for leading the build and deployment of classical Machine Learning and Generative AI systems to generate and validate concepts related to billing errors, audits, and fraud within large-scale healthcare payment data. The Staff Data Scientist will own the end-to-end delivery process, from problem framing and data strategy through model development, evaluation, deployment, and monitoring, focusing on reliability and customer outcomes.
The Staff Data Scientist will be responsible for advancing machine learning models used for identifying and auditing claims errors, requiring deep dives into clinical and coding data to improve audit precision. This role also involves enhancing data pipelines, modeling infrastructure, and team tools to scale capabilities and ensure model insights align with real business needs.
Develop new applications and contribute to UI and middle-layer development. Collaborate with team and external stakeholders to design and implement solutions for an intuitive user experience.
The DRG Reviewer will conduct thorough DRG payment validation reviews, including clinical and coding assessments of medical records according to contract-specific criteria. This involves meticulously documenting findings, providing clinical and policy support, and collaborating with stakeholders to ensure compliance with payment standards.
