Machinify
Complex Clinical Claims Analyst
Remote - US
Sponsorship not specified$100k-$110kDetected 11 days ago
Data AnalysisExcelAuditingResearchCollaborationProblem SolvingMicrosoft Office
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.
- About the Opportunity The Complex Clinical Review Analyst is responsible for reviewing facility claims to analyze the appropriateness of all billed charges compared to a medical record.
- This role requires research and content development for all aspects of claim review, including level of care, experimental and investigation services, HACs, and do not bill events.
Responsibilities
- Provide internal and external partners with evidence and references supporting industry standards, auditing guidelines, and review stances.
- Review, expand, and cultivate resources to build up complex claims review content.
- Collaborate and assist in staff training processes and development of training material as needed.
- Comply with company standards regarding productivity and audit accuracy to manage daily assignments and meet client turnaround times.
- Assists in special projects and perform other duties as needed.
- Optimize for customer impact
- Deliver results
Requirements
- Attends all required meetings.
- Bachelor of Science in Nursing, RN, LPN or LVN
- Experience with various software applications and collaboration with development teams
- We participate in E-Verify as required by applicable law.
Compensation
- $100,000 - $110,000
- This is an exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee's geographic location.
- In accordance with applicable state laws, we do not inquire about salary history during the recruitment process.
Benefits
- PTO, Paid Holidays, and Volunteer Days
- Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
- Tuition Reimbursement
- Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
Equal opportunity
- We are proud to be an equal opportunity workplace.
- If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know.
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.