The Sr. FWA Analyst identifies fraud, waste, and abuse in medical billing through data analysis, supporting engineering and data science teams with validation and tuning of detection algorithms.
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 Sr. FWA Analyst experienced in discovering medical billing errors and fraudulent billing patterns of medical claims for commercial payers.
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.
Similar Jobs
Artificial Intelligence • Healthtech • Machine Learning • Natural Language Processing • Biotech • Pharmaceutical
Leads Pfizer Oncology account marketing strategy, planning, commercialization, stakeholder alignment, field engagement, promotional execution, budgets, and GPO marketing plans. Advises senior leadership on policies, risks, opportunities, and strategic priorities while managing cross-functional teams and multiple portfolio assets. Requires extensive pharmaceutical commercial experience, oncology account expertise, strategic and analytical skills, leadership capability, compliance focus, and success in matrixed environments.
Artificial Intelligence • Healthtech • Machine Learning • Natural Language Processing • Biotech • Pharmaceutical
Field-based specialty pharmaceutical sales role promoting gastroenterology products across Kansas and Missouri. Responsibilities include engaging healthcare professionals, delivering compliant product and disease-state messaging, supporting formulary access and reimbursement resources, prioritizing accounts, collaborating with cross-functional teams, and optimizing territory activities through digital tools. Requires a bachelor’s degree or equivalent experience, at least three years of relevant pharmaceutical, biotech, medical device, marketing, or therapeutic healthcare experience, a valid U.S. driver’s license, and permanent U.S. work authorization.
Top Skills:
Digital Sales ToolsMicrosoft TeamsVeeva Engage
Artificial Intelligence • Healthtech • Machine Learning • Natural Language Processing • Biotech • Pharmaceutical
Drives pharmaceutical sales across an assigned cardiovascular territory by engaging healthcare providers in person and virtually. Develops territory and customer call plans, builds relationships, educates providers on approved products and disease-state information, analyzes business opportunities, and collaborates with internal teams. Completes administrative responsibilities compliantly while meeting sales and business-development objectives.
What you need to know about the Chicago Tech Scene
With vibrant neighborhoods, great food and more affordable housing than either coast, Chicago might be the most liveable major tech hub. It is the birthplace of modern commodities and futures trading, a national hub for logistics and commerce, and home to the American Medical Association and the American Bar Association. This diverse blend of industry influences has helped Chicago emerge as a major player in verticals like fintech, biotechnology, legal tech, e-commerce and logistics technology. It’s also a major hiring center for tech companies on both coasts.
Key Facts About Chicago Tech
- Number of Tech Workers: 245,800; 5.2% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: McDonald’s, John Deere, Boeing, Morningstar
- Key Industries: Artificial intelligence, biotechnology, fintech, software, logistics technology
- Funding Landscape: $2.5 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Pritzker Group Venture Capital, Arch Venture Partners, MATH Venture Partners, Jump Capital, Hyde Park Venture Partners
- Research Centers and Universities: Northwestern University, University of Chicago, University of Illinois Urbana-Champaign, Illinois Institute of Technology, Argonne National Laboratory, Fermi National Accelerator Laboratory
