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 Sr. FWA Analyst experienced in discovering medical billing errors and fraudulent billing patterns of medical claims for commercial payers.
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.
- 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.
Advantages
- Medical/clinical background.
- Experience with Pharma claims.
- Billing/coding experience.
Skills Required
- Experience in discovering medical billing errors and fraudulent billing patterns
- Hands-on experience with SQL/graph-based tools
- Extensive knowledge of medical terminology and health information management
- Strong analytical skills
- Background in SIU or Payment Integrity
What We Do
Team8 is a global venture group with deep domain expertise that creates companies and invests in companies specializing in enterprise technologies, cyber, AI, fintech and digital health. Leveraging an in-house, multi-disciplinary team of company-builders integrated with a dedicated community of C-level executives and thought leaders, Team8’s model is designed to outline big problems, ideate solutions, and help accelerate success through technology, market fit and talent acquisition. Team8’s leadership team represents serial entrepreneurs, industry pioneers and the former leadership of Israel’s elite tech and intelligence Unit 8200. Founded in 2014, Team8 is backed by global companies including Microsoft, Walmart, Cisco, Barclays and Moody’s, among others. To learn more about Team8 visit www.team8.vc
