Machinify - Content Innovation, Claims Editing (Multiple Levels)
Requirements
• 7+ years of experience in claims editing, clinical coding, Payment Integrity, or payer policy, with hands-on experience authoring or validating edits. • Active coding credential, such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license (such as RN) paired with deep coding experience. • Deep, current knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI, MUEs, coding guidelines, and documentation requirements. • Working knowledge of reimbursement methodologies, including fee schedules, DRGs, APCs, and professional and facility billing. • Experience sourcing and interpreting primary content, including CMS manuals, NCDs and LCDs, AMA guidance, and payer policies. • Strong analytical skills and comfort working with claims data, using SQL, Excel, or similar tools to test hypotheses and measure results. • Experience working with Product, Engineering, Data Science, or other multidisciplinary teams. • Clear written communication and the ability to explain complex coding and clinical logic to nonclinical audiences. • Curiosity about AI tools and willingness to use them in daily content work. • Sound judgment and comfort working in a fast-moving build-and-scale environment. • Preferred • Experience at a claims editing, Payment Integrity, or healthcare technology company. • Experience across commercial, Medicare Advantage, and Medicaid lines of business. • Clinical background (RN, LPN, or other licensed clinician) with direct patient care experience. • Experience writing product requirements or logic specifications for engineering teams. • Experience with Python, SQL, or BI tools for claims analysis. • Experience presenting content rationale or savings analyses to health plan clients. • What Success Looks Like… • The First 90 days • The First 90 days • You will learn Machinify’s content portfolio, source library, technology, and development process; build working relationships with Product and Data Science; and deliver your first validated content updates or new concepts. • Within 6 to 12 months • You will own a content domain end to end, move multiple data-validated concepts into production, maintain accurate and current source documentation, contribute to at least one AI-assisted improvement in how content is built, and show measurable results in edit accuracy, speed, or client value
Responsibilities
• Source and author editing content • Monitor and interpret authoritative sources, including CPT and HCPCS updates, ICD-10-CM guidelines, NCCI PTP and MUE tables, CMS manuals, NCDs and LCDs, specialty society guidance, and payer reimbursement policies. • Translate coding rules, clinical guidelines, and reimbursement policy into precise, testable editing logic. • Document the source, rationale, and scope of every edit so it is traceable, defensible on appeal, and easy to maintain. • Separate portable, market-wide content from client-specific policy, and flag the difference clearly in all content and sizing work. • Maintain existing content through quarterly code updates, policy changes, and performance reviews, and recommend when edits should be refined or retired. • Validate content with data • Use claims data to test editing concepts before build, size the opportunity, and estimate hit rate, false-positive rate, and savings. • Review edit output and production results to confirm edits fire as intended and to find gaps, over-reach, or missed opportunities. • Track measures such as accuracy, hit rate, false positives, appeals, overturns, provider abrasion, and realized savings. • Bring an analytical, value-first view to prioritization: what is the opportunity, how confident are we, and what will it return for the client? • Partner with Product and Data Science • Work with Product, Engineering, and Data Science to turn content concepts into clear requirements, logic specifications, and test cases. • Help data scientists understand clinical and coding context so models and analyses reflect how care is delivered and billed. • Evaluate where AI tools, including large language models, can speed up policy research, concept discovery, content authoring, and quality review. • Support clients and internal teams • Explain the rationale, sources, and expected impact behind editing content to client and internal audiences. • Support client policy review, edit approval, and appeals with clear, well-sourced documentation. • Bring client feedback and operational findings back into the content roadmap. • What experience you bring (Role Requirements)
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. • Remote and hybrid work options • What values we’ll share with you • Optimize for customer impact • Deliver results • Equal Employment Opportunity at Machinify • 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. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/
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