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Senior Content Analyst - Claims Editing

Remote Full-time

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Experience Level

Senior

Qualifications

Key Responsibilities:Interpret and apply CMS, Medicare, Medicaid, AMA/CPT, NCCI, and additional payer policies to establish accurate claims editing logic. Translate regulatory and coding guidance into clear, deterministic pre-pay edits, supported by documented rationale and references. Develop and maintain a proprietary library of claims edits that align with reimbursement rules and industry standards.

About the job

At Machinify, a premier healthcare intelligence firm, we specialize in enhancing the payment continuum, providing exceptional value, clarity, and efficiency to health plans nationwide. With deployment across over 85 health plans, including many of the top 20, and impacting more than 270 million lives, we combine a versatile, content-rich, AI-driven platform with unparalleled expertise. Our mission is to redefine industry standards, crafting straightforward and effective solutions to optimize financial outcomes and reduce healthcare expenses.

We are currently on the lookout for a talented Senior Content Analyst to become part of our Claims Editing team!

As a Senior Content Analyst within the Payment Integrity – Policy & Content Management team, you will be responsible for interpreting healthcare reimbursement policies and converting them into precise, automated claims editing logic that ensures payment accuracy. This role demands deep subject-matter expertise in applying regulatory guidance, coding standards, and payer rules to develop deterministic, testable edits that identify inaccuracies in coding, billing, and reimbursement. You will manage edit concepts comprehensively, from interpretation through validation and ongoing enhancement, with the opportunity to influence the evolution of content strategies. This position provides a high degree of autonomy and accountability for individuals who understand the intricacies of claims payment and excel at transforming complex regulations into straightforward, enforceable logic.

About Machinify, Inc.

Machinify, Inc. is at the forefront of healthcare intelligence, revolutionizing the payment continuum with cutting-edge technology and expert insights that drive efficiency and transparency for health plans across the United States.

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