Clinical Reviewer

2 months ago

Remote, Oregon, United States Health at Scale Full time

Health at Scale is the market leader in precision health -- digital health programs that offer smart, hyper-personalized insights to help individuals choose the best providers, treatments, care settings and lifestyle choices for their unique healthcare needs. Founded by leading machine learning and clinical faculty from MIT, Stanford, Harvard and the University of Michigan, we work with some of the largest payers, employers and providers in the U.S. to improve outcomes, costs, access, and equity for their members. Health at Scale operates some of the largest deployments of AI in healthcare to date, covering millions of lives in production settings. We have been recognized for our innovation and as one of the fastest growing private companies by Forbes, Fast Company, Inc 500, UCSF Digital Health, Becker's, TechCrunch, Bloomberg and MIT News. For more information, please visit our website.

As a Clinical Reviewer, you will work with an exceptional team of clinicians, engineers and data scientists to analyze healthcare data to improve utilization, authorization and payment workflows. You will collaborate with other members of the company's team to develop strategies and inform improvements to our products and bring in the next generation of payment integrity, utilization management and claims processing technologies.

Responsibilities

  • Conduct data analysis and evaluate healthcare records for inappropriate utilization and/or reimbursement
  • Work with other healthcare professionals to identify potential cases of fraud, waste, abuse and errors
  • Conduct thorough investigations of healthcare records and transactions
  • Develop and implement strategies to improve payment integrity, utilization management and claims processing
  • Develop reports and presentations on cases for management and other stakeholders
  • Stay current with healthcare regulations and policies

Requirements

  • Bachelor's degree in a healthcare, informatics or analytics-related discipline
  • Proficiency in Python programming language
  • Deep experience with healthcare data analysis in payment integrity, medical appropriateness, utilization management and/or special investigation
  • Strong analytical and problem-solving skills, well-organized, capable of performing background research and with thorough attention to detail
  • Excellent communication and interpersonal skills with ability to work independently and as part of a team
  • Knowledge of healthcare practices, coding, claims and utilization processing workflows

Health at Scale is an equal opportunity employer and is committed to diversity in its hiring and business practices. To all recruitment agencies: Health at Scale does not accept agency resumes. Please do not forward resumes to this job alias, company employees or any organization location. Health at Scale is not responsible for any fees related to unsolicited resumes.

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