Bluespine-sr. Fwa Analyst jobs at Team8

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

• 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

Building and leading a small team in charge of end-to-end cyber security research activities for Claroty’s US public sector solutions. Research areas include:

• Investigating new protocols used by IoT, OT, or IoMT technologies.
• Investigating the detection of false positives and recommending changes to the detection.
• Investigating asset classification issues in customer environments and resolving them with updated logic.
• Technical resource to support Sales lead Proof of Concepts.
• Creation of customer-facing dashboards and reports.
• Collection and enrichment of data and knowledge through external sources.
• Collaboration with Customers, and internal teams, to drive sales and customer success.
• Work with the Product team surrounding our always-evolving visibility capabilities.

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.