Re:Ask HN: Machine Learning Engineers, what do you do at work?
by DontchaKnowit on Monday June 10, 2024 @01:00PM
(#40635609)
Man, respectfully, sounds like you are doing the dirty immoral work of insurabce companies. AI algos for adding diagnoses to rack up the bill? That is completely disgusting. Wholly unnacceptable and if I ever find out ive been the target of such a scam I will raise holy hell.
Re:Ask HN: Machine Learning Engineers, what do you do at work?
by apwheele on Tuesday June 11, 2024 @06:54AM
(#40644748)
I am speaking more generally of the industry. You can look at my profile and follow the bread-trail to see whom I work for. It is not insurance, we are a client of state systems, and I work to do the opposite of what you suggest (identify fraud/waste/abuse in insurance claims).
I do not know the chances that any individual provider uses a system to identify what codes to tack onto your bill.
I am guessing every datascientist that works for a BlueCross BlueShield at individual states deals with processes that touch multiple-million dollars of claims.
We even now have various dueling systems -- one company has a model to tack on more diagnoses to push up the bill, another has a process to identify that upcoding. One company has models to auto accept/deny claims, another has an automatic prior authorization process to try to usurp that later denial stage, etc.