<div class="content-intro"><p><span style="color: rgb(0, 0, 0);">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. 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. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.</span></p></div><div id="message-list-preview-list_1775153128.800919"><div><div><div><div><div><div><div><div><div><div><div><strong>About the Role<br></strong><br>Machinify is seeking a<span class="Apple-converted-space"> </span><strong>Senior Analyst</strong><span class="Apple-converted-space"> </span>to lead the development and refinement of new reimbursement and payment integrity concepts. This is a<span class="Apple-converted-space"> </span><strong>hands-on healthcare domain role</strong>, not a technical or engineering position. The ideal candidate understands<span class="Apple-converted-space"> </span><strong>reimbursement logic, payment policies, and provider contracts</strong><span class="Apple-converted-space"> </span>in depth — and can translate that expertise into clear, structured concepts that inform analytics and automation efforts.<br>You’ll be focused on discovering where and why payment errors occur, designing methods to detect and prevent them, and partnering with technical teams to operationalize your findings. This role is ideal for someone who loves digging into claims data, identifying systemic payment issues, and shaping how technology solutions capture real-world reimbursement logic.<br><br><strong>What You’ll Do<br></strong><br>· Lead<span class="Apple-converted-space"> </span><strong>pre and post-pay claim reviews</strong><span class="Apple-converted-space"> </span>to identify inaccurate payments using reimbursement and contract expertise.<br>· Analyze and interpret<span class="Apple-converted-space"> </span><strong>provider contracts</strong><span class="Apple-converted-space"> </span>to ensure payments align with negotiated terms, methodologies, and payer rules.<br>· Collaborate closely with<span class="Apple-converted-space"> </span><strong>engineering and data science teams</strong><span class="Apple-converted-space"> </span>to translate business and reimbursement logic into analytical and automation frameworks.<br>· Research and document<span class="Apple-converted-space"> </span><strong>emerging reimbursement and contract patterns</strong>, coverage rules, and billing practices to inform concept development.<br>· Translate complex reimbursement and contract scenarios into<span class="Apple-converted-space"> </span><strong>structured rules and business logic</strong><span class="Apple-converted-space"> </span>for implementation.<br>· Analyze claim-level data to pinpoint root causes of overpayments or incorrect denials and recommend corrective approaches.<br>· Maintain expertise on CMS and commercial payer reimbursement guidelines.<br>· Support quality review, concept validation, and process improvement initiatives.<br><br><strong>Required Qualifications<br></strong><br>·<span class="Apple-converted-space"> </span><strong>5+ years</strong><span class="Apple-converted-space"> </span>experience in healthcare data mining or claims editing on the provider, payer, or vendor side<br>· Deep understanding of<span class="Apple-converted-space"> </span><strong>provider contracts</strong>, including rate structures, carve-outs, and reimbursement methodologies.<br>· Strong knowledge of<span class="Apple-converted-space"> </span><strong>claims processing, coding, billing, and payment logic</strong><span class="Apple-converted-space"> </span>across CMS and commercial payers.<br>· Proven ability to identify improper payment patterns, root causes, and opportunities for correction.<br>· Strong investigative and deductive reasoning skills; able to connect policy, data, and contractual details.<br>· Comfortable working in close<span class="Apple-converted-space"> </span><strong>collaboration with technical teams</strong><span class="Apple-converted-space"> </span>to guide implementation of business logic.<br>· Self-directed, detail-oriented, and adaptable to a<span class="Apple-converted-space"> </span><strong>fast-paced, growing environment</strong>.<br><br><strong>Preferred Qualifications<br></strong><br>· Coding or billing certifications.<br>· Working proficiency in<span class="Apple-converted-space"> </span><strong>SQL</strong><span class="Apple-converted-space"> </span>for data exploration and validation.<br>· Prior work in<span class="Apple-converted-space"> </span><strong>cross-functional R&D or innovation teams</strong><span class="Apple-converted-space"> </span>focused on healthcare payment integrity.</div></div></div></div></div></div></div></div></div></div></div></div><div> </div><div><span style="color: rgb(0, 0, 0);"><strong>What We Offer:</strong></span></div><ul><li style="color: rgb(0, 0, 0);"><span style="color: rgb(0, 0, 0);">Work from anywhere in the US! Machinify is digital-first.</span></li><li style="color: rgb(0, 0, 0);"><div><span style="color: rgb(0, 0, 0);">Top Medical/Dental/Vision offerings</span></div></li><li style="color: rgb(0, 0, 0);"><div><span style="color: rgb(0, 0, 0);">FSA/HSA</span></div></li><li style="color: rgb(0, 0, 0);"><span style="color: rgb(0, 0, 0);">Solid PTO program</span></li><li style="color: rgb(0, 0, 0);"><div><span style="color: rgb(0, 0, 0);">Tuition reimbursement</span></div></li><li style="color: rgb(0, 0, 0);"><div><span style="color: rgb(0, 0, 0);">Competitive salary, 401(k) with company match</span></div></li><li style="color: rgb(0, 0, 0);"><div><span style="color: rgb(0, 0, 0);">Additional health and wellness benefits and perks</span></div></li><li style="color: rgb(0, 0, 0);"><span style="color: rgb(0, 0, 0);">Flexible and trusting environment where you’ll feel empowered to do your best work</span></li></ul><div class="content-conclusion"><div><span style="color: rgb(0, 0, 0);"><strong>Equal Employment Opportunity at Machinify</strong></span></div><div> </div><div><span style="color: rgb(0, 0, 0);">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: <u><a id="m_4907613542122963413OWAae7934b9-fa06-3f98-e336-0c5f8a6d5638" style="color: rgb(0, 0, 0);" href="https://www.machinify.com/candidate-privacy-notice/" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://www.machinify.com/candidate-privacy-notice/&source=gmail&ust=1763168899816000&usg=AOvVaw0FJrzi47RtxTK_RN63lbaj">https://www.machinify.com/candidate-privacy-notice/</a></u></span></div></div>