The Payment Accuracy and Concept Lead develops and refines audit concepts in healthcare, collaborating with teams to identify errors in medical billing.
Description
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 Payment Accuracy and Concept Lead to discover medical billing errors and fraudulent billing patterns of medical claims for commercial payers.
Utilized Bluespine platform to develop and enhance new audit concepts using healthcare. Leads concept creation across multiple audit verticals, collaborating with R&D for testing
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
Similar Jobs
Big Data • Food • Hardware • Machine Learning • Retail • Automation • Manufacturing
Designs, engineers, governs, and optimizes SAP security and access controls across global S/4HANA environments. Responsibilities include SAP role architecture, authorization models, SAP GRC configuration, SoD analysis, privileged access controls, IAM integration, vulnerability management, audit compliance, security operations, and AI-enabled automation. The role partners with SAP Basis, functional teams, IAM, Cybersecurity, Audit, Compliance, and business stakeholders during SAP transformations, migrations, testing, cutover, and go-live activities.
Top Skills:
IamIgaMfaPamPimSailpointSap BtpSap Business AiSap FioriSap GrcSap Identity ManagementSap JouleSap S/4HanaSocSso
.png)
eCommerce • Fintech • Hardware • Payments • Software • Financial Services
Own and grow a Los Angeles sales territory through primarily in-person outreach. Generate leads, conduct business visits and product demos, build partnerships, manage the full sales cycle, close deals, and exceed quotas. Develop expertise across restaurant, retail, and service verticals while maintaining accurate Salesforce activity tracking, pipeline management, and forecasting. Partner cross-functionally to support seller onboarding and generate referrals.
Top Skills:
Payment Processing TechnologySalesforce
eCommerce • Fintech • Hardware • Payments • Software • Financial Services
Own and grow a local sales territory through primarily in-person execution. Generate leads through prospecting, community engagement, events, networking, and partnerships; conduct product demonstrations; close full-cycle deals; build seller relationships; support onboarding; develop referrals; maintain Salesforce pipeline discipline; forecast accurately; and consistently exceed quotas across restaurants, retail, and service businesses.
Top Skills:
Payment Processing TechnologySalesforce
What you need to know about the Los Angeles Tech Scene
Los Angeles is a global leader in entertainment, so it’s no surprise that many of the biggest players in streaming, digital media and game development call the city home. But the city boasts plenty of non-entertainment innovation as well, with tech companies spanning verticals like AI, fintech, e-commerce and biotech. With major universities like Caltech, UCLA, USC and the nearby UC Irvine, the city has a steady supply of top-flight tech and engineering talent — not counting the graduates flocking to Los Angeles from across the world to enjoy its beaches, culture and year-round temperate climate.
Key Facts About Los Angeles Tech
- Number of Tech Workers: 375,800; 5.5% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Snap, Netflix, SpaceX, Disney, Google
- Key Industries: Artificial intelligence, adtech, media, software, game development
- Funding Landscape: $11.6 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Strong Ventures, Fifth Wall, Upfront Ventures, Mucker Capital, Kittyhawk Ventures
- Research Centers and Universities: California Institute of Technology, UCLA, University of Southern California, UC Irvine, Pepperdine, California Institute for Immunology and Immunotherapy, Center for Quantum Science and Engineering
