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 • Consumer Web • Edtech • Enterprise Web • HR Tech • Social Impact • Generative AI
Lead operating expense forecasting and financial planning for the Global Enterprise business. Manage monthly and quarterly close processes, budgets, forecasts, variance analysis, and financial reviews. Partner with accounting and business teams to explain performance differences, refine projections, and identify strategic opportunities. Prepare leadership materials highlighting financial drivers, performance gaps, budget shortfalls, and growth opportunities.
.png)
Fintech • Insurance • Machine Learning • Analytics • Financial Services • Automation
Conduct audits of workers’ compensation claims files and handling processes to ensure regulatory, statutory, and internal compliance. Document findings, identify deficiencies, recommend corrective actions, monitor remediation, analyze quality trends, and prepare management reports. The role also develops quality-control procedures, supports external audits, trains claims staff, coaches adjusters, and collaborates with claims, compliance, learning, and analytics teams to improve claims quality and operational effectiveness.
Fintech • Insurance • Machine Learning • Analytics • Financial Services • Automation
Participate in monthly, quarterly, and annual accounting close processes by preparing journal entries, reconciliations, variance analyses, financial statements, and footnotes under U.S. GAAP. Support internal controls, process improvements, automation, system implementation, and accounting-related projects. Collaborate with Finance and cross-functional teams, vendors, partners, and related parties while ensuring accurate and timely completion of accounting tasks.
Top Skills:
Ai ToolsU.S. Gaap
What you need to know about the Colorado Tech Scene
With a business-friendly climate and research universities like CU Boulder and Colorado State, Colorado has made a name for itself as a startup ecosystem. The state boasts a skilled workforce and high quality of life thanks to its affordable housing, vibrant cultural scene and unparalleled opportunities for outdoor recreation. Colorado is also home to the National Renewable Energy Laboratory, helping cement its status as a hub for renewable energy innovation.
Key Facts About Colorado Tech
- Number of Tech Workers: 260,000; 8.5% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Lockheed Martin, Century Link, Comcast, BAE Systems, Level 3
- Key Industries: Software, artificial intelligence, aerospace, e-commerce, fintech, healthtech
- Funding Landscape: $4.9 billion in VC funding in 2024 (Pitchbook)
- Notable Investors: Access Venture Partners, Ridgeline Ventures, Techstars, Blackhorn Ventures
- Research Centers and Universities: Colorado School of Mines, University of Colorado Boulder, University of Denver, Colorado State University, Mesa Laboratory, Space Science Institute, National Center for Atmospheric Research, National Renewable Energy Laboratory, Gottlieb Institute
