Note: The job is a remote job and is open to candidates in USA. Machinify is a leading healthcare intelligence company focused on delivering value and efficiency to health plan clients. They are seeking a skilled Senior Content Analyst to interpret healthcare reimbursement policies and translate them into precise claims editing logic, ensuring payment accuracy and compliance.
Responsibilities
- Interpret and apply CMS, Medicare, Medicaid, AMA/CPT, NCCI, and other payer policies to define accurate claims editing logic
- Translate regulatory and coding guidance into clear, deterministic pre-pay edits, with documented rationale and references
- Build and maintain a proprietary library of claims edits aligned to reimbursement rules and industry standards
- Identify reimbursement risk areas and policy interpretation gaps and encode them into actionable edit concepts
- Own the development of high-quality edit specifications, including logic definitions, assumptions, edge cases, and validation criteria
- Analyze claims and edit performance data to confirm accuracy, reduce false positives, and prioritize enhancements by impact
- Conduct targeted manual claim reviews to validate coding accuracy, reimbursement correctness, and policy alignment
- Serve as a SME across Medicare, Medicaid, and commercial claims
- Partner with product, engineering, and implementation teams to ensure edits are implemented and validated correctly
- Clearly document edit logic, policy interpretation, and outcomes to support internal teams and payer stakeholders
- Proactively monitor regulatory updates, coding changes, and industry guidance to keep edits current and compliant
- Ensure all edits are auditable, defensible, and aligned with external policy sources
- Consistently meet productivity and quality expectations in a remote, outcomes-driven environment
Skills
- 4+ years of experience in authoring claims editing content with either vendors or payers
- Deep expertise in CMS policies (LCDs, NCDs, fee schedules)
- Deep expertise in NCCI (PTP and MUE) edits, OIG guidance, correct coding methodologies
- Deep expertise in CPT/HCPCS, ICD-10-CM/PCS, modifiers, place of service, and revenue codes
- Strong understanding of claims processing workflows (CMS-1500, UB-04)
- SQL skills for claims analysis or edit opportunity identification
- Clinical background (RN, BSN, PharmD, MD, or equivalent)
Benefits
- Work from anywhere in the US! Machinify is digital-first.
- Top Medical/Dental/Vision offerings
- FSA/HSA
- Solid PTO program
- Tuition reimbursement
- Competitive salary, 401(k) with company match
- Additional health and wellness benefits and perks
- Flexible and trusting environment where you’ll feel empowered to do your best work
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