Team8 Bluespine-Sr. FWA Analyst 

United States, Oregon 

409381738

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.