Codoxo is looking for a temporary full-time Payment Integrity Data Curator to support the development and refinement of AI-driven payment integrity products. This role involves expanding and curating high-quality datasets to improve AI performance, focusing on real-world payment integrity scenarios across medical and pharmacy domains.
Key responsibilities include:
- Reviewing historical payment integrity/SIU cases and claims data
- Identifying confirmed fraud, waste, abuse, and payment error scenarios
- Annotating claims and investigation outcomes for AI model training
- Providing feedback on AI tools analyzing medical records and investigation artifacts
- Reviewing synthetic healthcare datasets to validate realism
- Contributing to documentation and dataset curation guidelines
Qualifications:
- CPC, CFE, AHFI or equivalent credential
- Minimum 5 years in SIU/investigations, healthcare payment integrity, and auditing
- Expertise in coding and billing, fraud waste and abuse, and at least two of professional claims, facility claims, and medical record review
- Knowledge of DRG/APR-DRG auditing, medical necessity triggers, pharmacy & DME integrity, behavioral health coding preferred
- Strong understanding of payer systems, coding, and reimbursement methodologies (CPT, HCPCS, ICD-10) for Medicare, Medicaid, commercial payers
- Excellent communication skills
- Ability to work in a fast-paced, project-based environment
This position is suitable for experienced payment integrity professionals interested in healthcare AI product development. The work environment supports office or remote work.
Requirements & Qualifications
- CPC (Certified Professional Coder), CFE, AHFI or equivalent credential
- Minimum 5 years of experience in SIU/investigations, healthcare payment integrity, and auditing
- Expertise in coding and billing, fraud waste and abuse
- Experience in at least two areas: professional claims, facility claims, medical record review
- Knowledge of DRG/APR-DRG auditing, medical necessity triggers, high-cost drug/services, pharmacy & DME integrity, behavioral health and Psychotherapy coding is a plus
- Proven track record in identifying overpayments, waste, and abuse through claims analytics or audits
- Strong understanding of coding and reimbursement methodologies (CPT, HCPCS, ICD-10) for Medicare, Medicaid, and commercial payers
- Excellent communication skills
- Comfortable providing clear feedback regularly in a fast-paced environment
- Nice to have: proven innovation record and systems-approach mindset
Location
Georgia, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 month ago