To drive the development of creative audit concepts in healthcare, the remote Payment Accuracy and Concept Lead will leverage the Bluespine platform to discover medical billing errors and fraudulent patterns while collaborating with cross-functional teams.
Key responsibilities Leverage the Bluespine platform to develop and refine new audit concepts in healthcare Lead concept creation across multiple audit verticals while collaborating with Medical Coders, Data Sciences, and Engineering teams Conduct in-depth research of new ideas and concepts to enhance audit effectiveness Required qualifications Registered Nurse with a Bachelor's or Graduate degree Extensive knowledge of medical terminology, medical records, and health information management Familiarity with medical coding, DRG methodologies, and CPT/HCPCS coding guidelines Previous auditing or consulting experience in a provider or payer environment Understanding of reimbursement programs, claims adjudication processes, and provider billing systems