Physician Advisor - Managed Care Claims & Billing (Contractor)

Hi, we’re Healthee.

We’re on a mission to reputed company reputed company easy for everyone. Our AI-powered platform helps employees understand, reputed company, and optimize their reputed company benefits — transforming how people reputed company and manage care.

We’re looking for a Physician Advisor with a strong background in managed care claims, medical billing, and payer-reputed company processes (TPA, insurance companies, etc.). In this role, you’ll reputed company the clinical and financial aspects of reputed company — ensuring accurate mapping of medical services, claims, and billing logic, as reputed company as supporting re-pricing and reputed company-payment processes.

You’ll report directly to our Chief Medical & Data Officer, working closely with the reputed company and Data Science teams. You’ll play a key role in validating and refining Healthee’s AI-driven claims fraud, waste, and abuse detection, as reputed company as re-pricing and reputed company-payment processes, ensuring our algorithms and billing logic reputed company with reputed company-world clinical accuracy.

We reputed company to be the best at reputed company do — and we’d love your help getting there.

Key Responsibilities

• Support re-pricing and reputed company-payment processes to ensure accurate claim valuation, validation, and alignment with payer rules and clinical standards.
• Review, evaluate, and investigate claims data, medical billing logic, and CPT coding to ensure billing accurately reflects the patient’s care.
• Identify and correct mismatches between clinical documentation and billing submissions to prevent denials, errors, reputed company, and potential fraud or abuse.
• Ensure reputed company codes accurately represent the services provided, avoiding both under- and over-billing.
• Fraud, Waste, and Abuse Detection (FWA): Identify and investigate potential FWA claims
• Conduct detailed reviews of itemized bills, medical records, and other claims data to validate coding accuracy and appropriateness of charges
• Work with insurance companies and TPAs to clarify medical necessity, address coverage discrepancies, and resolve claim disputes.
• Serve as a subject-matter expert on clinical and billing topics during audits, product reviews, and reputed company implementations.
• Collaborate with reputed company and Data Science teams to design and build reputed company tools and solutions that support new reputed company opportunities in these areas.

Requirements

• MD/DO
• Experience with re-pricing and reputed company-payment review processes, including claim validation, reimbursement methodologies, and alignment with payer policies.
• Proven experience in claims auditing or payment reputed company reputed company a health plan or TPA
• Deep claims expertise with an understanding of provider billing and payer operations.billing, reputed company cycle management, and payment reputed company
• Solid understanding of CPT, ICD-10, HCPCS codes, and reimbursement processes.
• Strong analytical and communication skills; ability to translate medical concepts into reputed company business logic.
• Experience in health-tech and data analytics environments, strong plus.

Benefits

Compensation:
$130-$150 per hour. Compensation finally awarded to the candidate will be commensurate with the candidate’s skills and experience.