Develop, maintain, test, and optimize payment integrity audit concepts for durable medical equipment, home health, and home infusion claims, ensuring alignment with coding standards, payer policies, and regulatory requirements. Support audit operations through policy guidance, training, analytics, client collaboration, quality assurance, and workflow improvements.
Audit inpatient and outpatient medical claims for commercial and government payers, document findings using applicable policies and guidelines, and support appeals when needed. Collaborate on audit improvements, medical policies, provider education, quality assurance, training, and development of review guidelines and system edits.
Own the full proposal lifecycle for government and commercial healthcare opportunities, from intake through submission. Orchestrate cross-functional subject matter experts and leverage AI tools to build a structured, high-quality content engine.
Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise. Collaborate with engineering and data science teams to translate business logic into analytical and automation frameworks.
The Senior Analyst will lead the development of new reimbursement and payment integrity concepts by analyzing claims data and provider contracts. They will collaborate with engineering and data science teams to translate complex business logic into effective analytical and automation frameworks.
The analyst is responsible for developing, validating, and maintaining clinical and coding audit concepts to ensure payment integrity. They collaborate with cross-functional teams to interpret regulatory changes and payer policies while leveraging AI tools to optimize audit performance.
You will source, design, validate, and maintain clinical and coding content for AI-powered editing products. You will also partner with product and data science teams to turn content concepts into testable logic and measurable value for health plan clients.
You will design, validate, and maintain clinical and coding content for healthcare payment editing products with a focus on New York State Medicaid. The role involves collaborating with product and data science teams to translate complex reimbursement policies into testable editing logic.
The role involves sourcing, designing, and maintaining clinical and coding content for specialty pharmacy and high-cost drug editing products. You will collaborate with product and data science teams to validate content using claims data and ensure accurate, defensible payment integrity outcomes.
Perform medical claims audit reviews for government clients by applying appropriate medical review guidelines and policies. Document findings, generate audit letters, and support findings during the appeals process while collaborating with the audit team.
You will redesign data layers for AI products and build a robust Rust framework to improve service performance and correctness. Additionally, you will drive the adoption of AI tools across the company and improve observability and resilience across the platform.
The Leave of Absence Manager owns the end-to-end administration of all employee leave programs, including FMLA, ADA accommodations, and state-specific leaves. Additionally, the role provides cross-functional support to the benefits team for health, welfare, and retirement plan administration.
The Assistant General Counsel will own the drafting and negotiation of AI, data, and IP terms within commercial agreements. They will partner with Sales and Client Success teams to ensure contract terms align with product architecture and regulatory requirements.
The Product Marketing Manager will develop foundational messaging, positioning, and value propositions while supporting product launches and sales enablement. They will also create core marketing assets and translate complex AI-powered healthcare capabilities into clear, compelling narratives for diverse payer audiences.
Lead the DRG team and manage clinical claims review, including DRG validation, readmissions, and place-of-service reviews. Develop and improve clinical solutions, policies, workflows, and reporting while coordinating with clients and cross-functional teams to identify and correct claims issues.
You will own the analytics layer by modeling complex healthcare operational data into certified dimensional models and building governed semantic layers. Additionally, you will manage visualization dashboards, data observability, and orchestration workflows to ensure business leaders have accurate, actionable metrics.
The Senior Product Designer will leverage design thinking to create innovative solutions and conduct user research to inform product development. They will also collaborate with cross-functional teams to produce wireframes, prototypes, and design specifications while maintaining design systems.
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 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.
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.
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.
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.
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.
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.
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.
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 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.
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.
