Bluespine-Payment Accuracy and Concept Lead (AI-Driven)
Core
Develop and refine AI-driven audit concepts to detect medical billing errors and fraudulent patterns for commercial payers.
Role type
Senior IC payment accuracy and concept lead (healthcare AI)
Builds
New audit concepts and detection logic for medical claims
Domain
Health-IT / Medical Billing / Commercial Payers
Deliverable
production ML models
Required skills
Medical terminology, medical records management, medical coding (CPT/HCPCS), DRG methodologies, claims adjudication processes, provider billing systems, reimbursement programs, member contract benefits
Preferred skills
Auditing or consulting experience in provider/payer environments, experience with self-insured companies
Technologies
Bluespine platform (via careerplan.io/jobs/61-003-1F-05A-bluespine-payment-accuracy-and-concept-lead-ai-driven)
Responsibilities
Leverage the Bluespine platform to develop and refine new audit concepts in healthcare; Lead concept creation across multiple audit verticals; Conduct in-depth research of new ideas and concepts
Seniority
Senior, hands-on IC
