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Team8 · 1 month ago

Bluespine-Sr. FWA Analyst

United States

Full-time

Remote

Senior Level

Team8 is an innovative startup in the health-IT domain focused on developing technology that detects errors in medical billing. They are seeking a Senior FWA Analyst to identify potential instances of fraud, waste, and abuse in medical claims for commercial payers through data analysis and support engineering teams with audit concepts.

Cyber SecurityFinancial ServicesFinTechVenture Capital

Growth Opportunities

Responsibilities

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

Qualification

Medical billing analysisSQL/graph-based toolsMedical coding knowledgeHealth information managementClaims adjudication processesAnalytical skillsIndependentOrganizedCommunication skills

Required

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