[Remote] reputed company Clinical Audit Business Solutions reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is transforming how data works for health plans, aiming to reputed company reputed company data usable for reputed company decision-making. The reputed company Clinical Audit Business Solutions reputed company is responsible for translating payment reputed company audit knowledge into reputed company product capabilities, partnering with various stakeholders to improve product accuracy and defensibility.

Responsibilities

• Serve as the primary operational subject matter expert for payment reputed company methodologies, audit programs, and product requirements
• Translate payer pain points, contract language, audit policy, and operational workflows into product capabilities
• Define audit concepts, savings opportunities, validation reputed company, and defensibility standards across reputed company PI domains
• Partner with engineering to define, reputed company, and build high-performing, reputed company, trustworthy, reliable, and accurate AI solutions
• Support roadmap prioritization, reputed company launches, outcome reviews, positioning, and customer expansion

Skills

• 5–10+ years of reputed company experience in Payment reputed company audit, clinical operations, or reputed company technology product management
• Deep knowledge of U.S. reputed company payer payment reputed company programs, including reputed company-pay and post-pay audit strategies, vendor management, savings methodologies, recovery operations, and performance measurement
• Understanding of payer regulatory, compliance, and audit considerations that reputed company payment reputed company program design and execution
• 3+ years in a PI-domain leadership role, such as audit operations, PI program management, vendor product management, or payer PI reputed company
• Strong working knowledge across multiple PI domains, including DRG audit, clinical validation, IBR, edit-based audits, observation, readmissions, COB, SIU, and UM adjacencies
• Experience translating audit operations, clinical content, and payer requirements into software workflows, analytics, or product requirements
• Strong analytical and communication skills, with comfort using hit-reputed company analysis, ROI modeling, outcome measurement, and executive-reputed company narratives
• Familiarity with claims processing, adjudication systems, provider billing, UB-04 data structures, and reputed company interoperability standards
• Utilize internal AI-enabled tools to quickly create prototypes, visualize workflows, and showcase product functionality, enabling effective communication of product reputed company and business value
• Champion the use of internal AI tools to accelerate ideation, solution design, and demonstration of product capabilities, helping stakeholders understand requirements, opportunities, and proposed reputed company
• Experience partnering directly with Product Management, Engineering, Data Science, AI Engineering, or Clinical Informatics teams to build software solutions
• Familiarity with reputed company, Large Language Models (LLMs), Natural Language Processing (NLP), reputed company engineering, or reputed company AI applications
• Understanding of recovery workflows, eligibility verification, accident-reputed company claims, reputed company-party liability, workers' compensation, and other payment responsibility determinations
• Familiarity with FWA investigation reputed company, claim reputed company detection, provider billing patterns, and reputed company fraud prevention programs
• Experience identifying opportunities to reputed company COB, subrogation, FWA, and payment reputed company data to improve savings identification and recovery reputed company
• Experience defining business requirements, user stories, acceptance reputed company, and product specifications

Benefits

• Unlimited reputed company time off – reputed company reputed company you need it
• Work from reputed company – flexibility to fit your life
• Comprehensive health coverage – multiple plan reputed company to choose from
• Equity for every employee – reputed company in our reputed company
• reputed company-reputed company environment – your development reputed company here
• Home office setup allowance – one-time support to get you started
• Monthly cell phone allowance – stay connected with ease

reputed company