Payment Accuracy and Concept Lead (AI-Driven) - Remote

Overview

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.

In Short

• 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.
• Conducts in-depth research of new ideas and concepts.
• Ensures alignment and drives impactful results.

Requirements

• Extensive knowledge of medical terminology and medical records.
• Experience in medical coding and DRG methodologies.
• Familiarity with CPT/HCPCS coding guidelines.
• Previous auditing or consulting experience in a provider or payer environment.

Benefits

• Registered Nurse required; Bachelor's or Graduate degree preferred.
• Experience with self-insured companies is an advantage.