Payment Accuracy and Concept Lead (AI-Driven) at Team8

, Oregon, United States -

Full Time

Start Date

Immediate

Expiry Date

16 May, 26

Salary

0.0

Posted On

15 Feb, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

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, Provider Billing Systems, Auditing, Consulting, Data Sciences, Engineering, Registered Nurse

Industry

Venture Capital and Private Equity Principals

Description

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

Responsibilities

The Lead will leverage the Bluespine platform to develop and refine new audit concepts in healthcare, leading concept creation across multiple audit verticals. This role involves close collaboration with Medical Coders, Data Sciences, and Engineering teams to ensure alignment and drive impactful results, including in-depth research of new ideas and concepts.