Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse.  Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques.

 

We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry. 


Position Summary: 

We seek a highly motivated and creative individual to join our team as a Payment Integrity Innovation Specialist to ideate and advance the development of new rules, models, and detection capabilities. As a Payment Integrity Innovation Specialist, you will be critical in developing new and innovative solutions to payment integrity challenges in the healthcare industry. You will be responsible for identifying emerging trends and risks, developing creative solutions, and working with cross-functional teams to implement those solutions.

 

The ideal candidate will be a self-motivated individual with a curiosity and a thirst for finding and rapidly implementing new effective ways to drive healthcare affordability and cost containment. The candidate should be comfortable working in a fast-paced and ever-changing environment. They should be able to adapt to new challenges and priorities quickly and effectively. 

 

Key Responsibilities:

Apply your knowledge in developing and evolving Payment Integrity concepts and methodologies to enhance payment accuracy, minimize overpayments, and identify potentially fraudulent activities. Collaborate with cross-functional teams to create innovative solutions for improving payment integrity processes.

 

  • Utilize data analytics and business intelligence tools to identify patterns, anomalies, and emerging payment integrity trends and risks specific to the healthcare industry
  • Rapidly develop and propose innovative payment integrity solutions tailored to deliver value and greater savings for customers
  • Work as an individual contributor but collaborate with cross-functional teams to implement payment integrity solutions within the healthcare context
  • Monitor the effectiveness of payment integrity solutions and make improvements based on healthcare data insights
  • Stay up-to-date on the latest payment integrity technologies and trends with a focus on healthcare payment accuracy
  • Maintain up-to-date documentation on payment integrity innovations, ensuring knowledge transfer within the organization

 

Qualifications:

  • Bachelor's degree in a relevant field, such as finance, risk management, healthcare data analytics, computer science, or relevant working experience
  • 3+ years of experience in payment integrity or a related field, with a preference for experience in healthcare claims data analysis
  • Proven ability to identify and solve complex problems related to healthcare data
  • Strong analytical and problem-solving skills
  • Excellent communication and presentation skills
  • Experience with payment integrity detection development and implementation, with a preference for healthcare-specific solutions
  • Experience with data analysis, including SQL is required while Python is strongly preferred

 

If you are a highly motivated and creative individual with a passion for payment integrity and a knack for innovation, we encourage you to apply. We are excited to find the right person to join our team and make a real impact on healthcare affordability.

 

Please share examples or summaries of successful payment integrity innovations you have implemented.

 

 

Benefits for You

  • Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)
  • Unlimited PTO
  • Annual Professional Development stipend
  • Annual home office stipend
  • 401K Match (after 90 days)

 

We are an Equal Opportunity Employer:

Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.  This policy applies to all terms and conditions of employment.

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