Team8

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

Team8 • $110K — $130K *
US-Anywhere
+ 2 other locationsRemote
Healthcare
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Extensive knowledge of medical terminology and health information management.
  • Familiarity with medical coding and reimbursement programs.
  • Understanding of claims adjudication processes and provider billing practices.
  • Experience in auditing or consulting within healthcare settings.
  • Registered Nurse certification required; Bachelor’s or higher education preferred.

Responsibilities

  • Leverage Bluespine platform for audit concept development in healthcare.
  • Lead creation of innovative audit concepts across various verticals.
  • Collaborate effectively with Medical Coders, Data Sciences, and Engineering teams.
  • Conduct comprehensive research on new healthcare concepts and ideas.

Benefits

  • Opportunity to work with innovative technologies like Bluespine platform.
  • Collaborative work environment with cross-functional teams.
  • Engagement in impactful healthcare auditing projects.
Full Job Description
Description

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

About Team8

Team8 is a venture capital firm that invests in cybersecurity, data analytics, and artificial intelligence startups. The firm was founded in 2014 by a group of former leaders of the Israeli Defense Forces' elite technology and intelligence unit, Unit 8200. Team8 provides its portfolio companies with access to its network of experts and resources, and helps them develop and commercialize their technologies. The firm is headquartered in Tel Aviv, Israel.
Learn more about Team8
Size
50 employees
Industry
Finance & Insurance
Founded
2014
* Ladders Estimates

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