Description review
Bluespine-Payment Accuracy and Concept Lead (AI-Driven)
Team8 · United States · back to the listing
HR standards
46/100
poor
Title ↔ description
60/100
needs work
Reads as
Business Analyst
85% confident
What this role officially is
ICT business analyst — ESCO, the EU occupation classification
ICT business analysts are in charge of analysing and designing an organisation's processes and systems, assessing the business model and its integration with technology. They also identify change needs, assess the impact of the change, capture and document requirements and then ensure that these requirements are delivered whilst supporting the business through the implementation process.
Also known as: ICT business analysts, business process specialist, IT business analyst
How others title the same work
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- Strategic Projects Associate Corgi Insurance
What the listing never says
- No pay range published. Candidates cannot tell whether applying is worth their time. Pay transparency
- No location or timezone policy stated, so a candidate cannot tell where they may work from. Scope clarity
The listing, marked up
Nothing in the wording of this listing tripped a check. The scores above still judge how complete and coherent it is.
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
Originally posted on Himalayas
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
Originally posted on Himalayas