# Physician Advisor - Managed Care Claims & Billing (Contractor)

> Healthee · United States (Remote) · Contract · Posted 2026-06-04

**Workplace:** remote

## Description

Hi, we’re Healthee.  
  
We’re on a mission to make healthcare easy for everyone. Our AI-powered platform helps employees understand, navigate, and optimize their healthcare benefits — transforming how people access and manage care.

We’re looking for a **Physician Advisor with a strong background in managed care claims, medical billing, and payer-side processes** (TPA, insurance companies, etc.). In this role, you’ll bridge the clinical and financial aspects of healthcare — ensuring accurate mapping of medical services, claims, and billing logic, as well as supporting re-pricing and pre-payment processes.  
  
You’ll report directly to our Chief Medical & Data Officer, working closely with the Growth 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 well as re-pricing and pre-payment processes, ensuring our algorithms and billing logic align with real-world clinical accuracy.

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

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Key Responsibilities

-   Support re-pricing and pre-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, compliance risks, and potential fraud or abuse.
-   Ensure all 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 client implementations.
-   Collaborate with Growth and Data Science teams to design and build scalable tools and solutions that support new growth opportunities in these areas.

## Requirements

-   MD/DO
-   Experience with re-pricing and pre-payment review processes, including claim validation, reimbursement methodologies, and alignment with payer policies.
-   Proven experience in claims auditing or payment integrity within a health plan or TPA
-   Deep claims expertise with an understanding of provider billing and payer operations.billing, revenue cycle management, and payment integrity
-   Solid understanding of CPT, ICD-10, HCPCS codes, and reimbursement processes.
-   Strong analytical and communication skills; ability to translate medical concepts into structured 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._

## Apply

[Apply at Healthee](https://apply.workable.com/healthee/j/58E55A4DE0/apply)

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