Senior Content Analyst (Claims editing)

Responsibilities

• 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.
• 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.

Requirements

• Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise.
• experience in authoring claims editing content with either vendors or payers Deep expertise in:
• NCCI (PTP and MUE) edits, OIG guidance, correct coding methodologies
• 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). What We Offer:

Experience

• Consistently meet productivity and quality expectations in a remote, outcomes-driven environment. What You Bring: 4+ years of

Benefits