Team8

Senior FWA Analyst

Team8

full-time

Posted on:

Location Type: Remote

Location: United States

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Job Level

Senior

Tech Stack

SQL

About the role

  • 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.

Requirements

  • 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.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
data analysisSQLgraph-based toolsanomaly detection algorithmsmedical codingDRG methodologiesCPT codingHCPCS codingclaims adjudicationdata mapping
Soft Skills
analytical skillsscientific approachindependenceorganizationcommunication