Clinical Reviewer
Posted on 3/24/2024
HEALTH[at]SCALE

11-50 employees

ML precision delivery healthcare company
Company Overview
HEALTH[at]SCALE is on a mission to usher in a new era of care that is proactive, personalized, and precise. HEALTH[at]SCALE is a healthcare machine intelligence company that uses proprietary advances in artificial intelligence and machine learning to optimize care delivery for individuals by empowering at-risk payers, employers and providers.
Data & Analytics
Social Impact
Cybersecurity
AI & Machine Learning
Financial Services
Consumer Goods

Company Stage

Series A

Total Funding

$16M

Founded

2015

Headquarters

San Jose, California

Growth & Insights
Headcount

6 month growth

-6%

1 year growth

-6%

2 year growth

38%
Locations
Remote in USA
Experience Level
Entry
Junior
Mid
Senior
Expert
Desired Skills
Communications
Management
Data Analysis
CategoriesNew
Medical, Clinical & Veterinary
Diagnostics & Laboratory Professionals
Healthcare Administration & Support
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
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