Machinify is a healthcare intelligence company focused on payment integrity across the healthcare payment continuum. The company supports health plan clients nationwide with an AI-powered platform and specialized expertise.
This role sits on the Complex Payment Solutions team and is responsible for developing, maintaining, testing, and optimizing payment integrity audit concepts across government and commercial claim types. The position partners with operations, clinical, client services, and technology teams to ensure concepts are accurate, compliant, and aligned with coding standards, medical necessity criteria, regulatory requirements, and payer policies.
The analyst also monitors concept performance, supports process improvements, creates documentation and training materials, and provides subject matter expertise to internal teams and clients.
Required qualifications
- Active RN license or certified coder credential such as CPC, CCS, CIC, or COC
- Bachelor's degree in health administration, business, nursing, or a related field, or equivalent experience
- 5+ years of progressive experience in healthcare claim subject matter expertise, including payment integrity and claims auditing
- Equivalent consideration for 3+ years of claims auditing and recovery auditing experience
- Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and HIPPS coding systems
- Experience with MS-DRG, APR-DRG, APC, APG, PDPM, and PDGM payment methodologies
- Deep understanding of Medicare and commercial coding rules, reimbursement policies, and adjudication standards
- Experience developing clinical content, policy documentation, and training resources
- Strong analytical, critical thinking, and communication skills
- Ability to manage multiple concurrent workflows independently in a remote environment
- Proficiency with Microsoft Office tools, especially Excel and PowerPoint
- Familiarity with encoder/grouper applications and software collaboration tools
Preferred capabilities
- Ability to mentor and oversee subject matter experts
- Experience with data analysis, scoring, and selection for audit concepts
- Experience collaborating with development teams
Benefits and perks
- Work from anywhere in the US
- Medical, dental, and vision coverage
- FSA/HSA options
- Tuition reimbursement
- Competitive salary
- 401(k) with company match
- Additional health and wellness benefits and perks
- Flexible, trusting, digital-first work environment
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Salary Range
$80,000 - $120,000
Remote work allowed
Yes
Posted
1 month ago