Physician Advisor – Managed Care Claims & Billing

🔥 11 minutes ago

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Healthee

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2021

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

💰 $30M Series B on 2025-05

Healthcare Insurance • SaaS • Artificial Intelligence

Healthee is an AI-powered employee benefits platform that streamlines healthcare navigation and benefits administration for employers, HR teams, brokers, TPAs, and PEOs. Its offerings include Zoe, an AI healthcare virtual assistant, telehealth services, an AI-driven plan comparison tool, cost-transparency and provider search, pharmacy/Rx management, and claims analytics including fraud, waste, and abuse detection. Healthee focuses on reducing administrative workload, improving benefits utilization, and containing healthcare costs through automation, personalization, and real-time decision support.

📋 Description

• Support re-pricing and pre-payment processes to ensure accurate claim valuation, validation, and alignment with payer rules and clinical standards. • Review, evaluate, and investigate claims data, medical billing logic, and CPT coding to ensure billing accurately reflects the patient’s care. • Identify and correct mismatches between clinical documentation and billing submissions to prevent denials, errors, compliance risks, and potential fraud or abuse. • Ensure all codes accurately represent the services provided, avoiding both under- and over-billing. • Fraud, Waste, and Abuse Detection (FWA): Identify and investigate potential FWA claims • Conduct detailed reviews of itemized bills, medical records, and other claims data to validate coding accuracy and appropriateness of charges • Work with insurance companies and TPAs to clarify medical necessity, address coverage discrepancies, and resolve claim disputes. • Serve as a subject-matter expert on clinical and billing topics during audits, product reviews, and client implementations. • Collaborate with Growth and Data Science teams to design and build scalable tools and solutions that support new growth opportunities in these areas.

🎯 Requirements

• MD/DO • Experience with re-pricing and pre-payment review processes, including claim validation, reimbursement methodologies, and alignment with payer policies. • Proven experience in claims auditing or payment integrity within a health plan or TPA • Deep claims expertise with an understanding of provider billing and payer operations.billing, revenue cycle management, and payment integrity • Solid understanding of CPT, ICD-10, HCPCS codes, and reimbursement processes. • Strong analytical and communication skills; ability to translate medical concepts into structured business logic. • Experience in health-tech and data analytics environments, strong plus.

🏖️ Benefits

• **Compensation**:***$130-$150 per hour.* Compensation finally awarded to the candidate will be commensurate with the candidate’s skills and experience. *