FWA Analyst

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January 14

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Team8

WebsiteLinkedInAll Job Openings

Enterprise • Cybersecurity • Fintech

Team8 is a company builder and venture group that partners with entrepreneurs to co-found companies in enterprise technology, cybersecurity, artificial intelligence, fintech, and digital health industries. They focus on providing an unfair advantage to startups by integrating expertise, resources, and a community of C-level executives known as the 'Village'. Team8 emphasizes building innovative companies that address significant challenges and opportunities, with a model that involves leading investments in early-stage rounds and collaborating closely with enterprises to facilitate digital transformation.

51 - 200 employees

Founded 2014

🏢 Enterprise

🔒 Cybersecurity

💳 Fintech

📋 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. • We are looking for an FWA Analyst experienced in discovering medical billing errors and fraudulent billing patterns of medical claims for commercial payers. • Proactively identify potential instances of fraud, waste, and abuse through data analysis using company systems and tools. • Support engineering and data science teams with audit and FWA concepts, data mapping, and defining data requirements. • Determine the likelihood of cases being true error/fraud, based on real-life experience. • Validate and help to tune anomaly detection algorithms.

🎯 Requirements

• Hands-on experience exploring and investigating potential medical billing errors/fraud using analytic and SQL/graph-based tools. • 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, regulatory agency policies (CMS/HCFA, DOI, state regulations), and provider billing systems and practices. • Strong analytical skills and ability to approach tasks in a scientific manner. • Background in SIU or Payment Integrity. • Independent, Organized, and with excellent communication skills.