Bluespine is an innovative startup in the health-IT domain developing a medical billing error detection engine aimed at reducing industry-wide losses.
As a Senior FWA (Fraud, Waste, and Abuse) Analyst, you will identify medical billing errors and fraudulent patterns within commercial payer medical claims.
Responsibilities include proactively identifying potential fraud, waste, and abuse via data analysis; supporting engineering and data science teams with audit concepts, data mapping, and requirements; determining likelihood of fraud/error based on experience; and validating anomaly detection algorithms.
Candidates should have hands-on experience investigating medical billing errors/fraud using analytics and SQL/graph tools; extensive knowledge of medical terminology, records, coding (DRG, CPT/HCPCS), reimbursement, claims adjudication, member benefits, CMS/HCFA and other regulations, and provider billing practices; strong analytical skills; SIU or payment integrity background; independence, organization, and excellent communication skills.
Advantages include medical/clinical background, pharma claims experience, and billing/coding experience.
Hands-on experience with investigating medical billing errors and fraud using analytics and SQL/graph tools. Extensive knowledge of medical terminology, medical records, health information management, coding methodologies (DRG, CPT/HCPCS), physician specialty guidelines, reimbursement programs, claims adjudication processes, member benefits, CMS/HCFA and state regulations, provider billing systems. Strong analytical and scientific approach skills. Background in Special Investigations Units (SIU) or Payment Integrity. Independent, organized, excellent communicator.
Preferred: Medical or clinical background, pharma claims experience, billing/coding experience.
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
2 months ago