Machinify
Senior Content Analyst (Claims editing)
US · Senior
Sponsorship not specifiedDetected 49 days ago
SQLICD-10Claims Management
About the role
- Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country.
- We're seeking a skilled Senior Content Analyst to join our Claims Editing team!
- This role offers high autonomy and ownership for someone who understands how claims should be paid and thrives on turning complex rules into clear, enforceable logic.
Responsibilities
- Own the development of high-quality edit specifications, including logic definitions, assumptions, edge cases, and validation criteria.
- 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.
Requirements
- 4+ years of experience in authoring claims editing content with either vendors or payers
- Deep expertise in:
- Strong understanding of claims processing workflows (CMS-1500, UB-04).
- CMS policies (LCDs, NCDs, fee schedules)
- NCCI (PTP and MUE) edits, OIG guidance, correct coding methodologies
- CPT/HCPCS, ICD-10-CM/PCS, modifiers, place of service, and revenue codes
- Extra points if you bring:
- SQL skills for claims analysis or edit opportunity identification.
- Clinical background (RN, BSN, PharmD, MD, or equivalent).
Compensation
- Competitive salary, 401(k) with company match
- The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc.
Benefits
- Top Medical/Dental/Vision offerings
- Solid PTO program
- Tuition reimbursement
- Additional health and wellness benefits and perks
- Flexible and trusting environment where you'll feel empowered to do your best work
- 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.
- Conduct targeted manual claim reviews to validate coding accuracy, reimbursement correctness, and policy alignment.
Company info
- We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range.
- We are proud to be an
Equal opportunity
- equal opportunity workplace.
Visa & Work Authorization
- al 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
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This listing is sourced directly from Machinify's careers page and normalized into a canonical job model.