Payment Accuracy and Concept Lead (AI-Driven)

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