Machinify is hiring a Senior Content Analyst (Claims editing)

Machinify is looking for a Senior Content Analyst (Claims Editing) to interpret complex healthcare reimbursement policies and translate them into precise, automated claims editing logic that drives payment accuracy. You will own edit concepts end-to-end, from interpretation through validation and ongoing refinement.

What You'll Do

• 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 subject matter expert 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.

What We're Looking For

• 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, and 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).

Nice to Have

• SQL skills for claims analysis or edit opportunity identification.
• Clinical background (RN, BSN, PharmD, MD, or equivalent).

Team & Environment

You will be part of the Claims Editing team within the Payment Integrity – Policy & Content Management team.

Benefits & Compensation

• Work from anywhere in the US.
• Top Medical, Dental, and 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.

Work Mode

This is a remote position open to candidates anywhere in the United States.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status.