Senior Analyst, Data Mining

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November 13

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Machinify, Inc.

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Artificial Intelligence • Healthcare Insurance • Fintech

Machinify, Inc. is a company specializing in artificial intelligence solutions for the healthcare industry, particularly in optimizing payment processes and enhancing payment integrity. Their product suite, including Machinify Audit and Machinify Pay, is designed to automate and improve the accuracy of medical claims review, identifying billing and coding errors, and reducing administrative costs. Machinify's AI-driven platform covers millions of healthcare members and delivers significant financial benefits by efficiently processing medical claims and empowering health plans to tailor their policies. With a focus on transparency, control, and safety in AI, Machinify offers customized solutions that adapt to the specific needs of healthcare providers and contribute to the transformation of healthcare payments.

51 - 200 employees

🤖 Artificial Intelligence

⚕️ Healthcare Insurance

💳 Fintech

💰 $10M Series A on 2018-10

📋 Description

• Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise. • Analyze and interpret provider contracts to ensure payments align with negotiated terms, methodologies, and payer rules. • Collaborate closely with engineering and data science teams to translate business and reimbursement logic into analytical and automation frameworks. • Research and document emerging reimbursement and contract patterns, coverage rules, and billing practices to inform concept development. • Translate complex reimbursement and contract scenarios into structured rules and business logic for implementation. • Analyze claim-level data to pinpoint root causes of overpayments or incorrect denials and recommend corrective approaches. • Maintain expertise on CMS and commercial payer reimbursement guidelines. • Support quality review, concept validation, and process improvement initiatives.

🎯 Requirements

• 5+ years experience in healthcare data mining or claims editing on the provider, payer, or vendor side • Deep understanding of provider contracts, including rate structures, carve-outs, and reimbursement methodologies. • Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers. • Proven ability to identify improper payment patterns, root causes, and opportunities for correction. • Strong investigative and deductive reasoning skills; able to connect policy, data, and contractual details. • Comfortable working in close collaboration with technical teams to guide implementation of business logic. • Self-directed, detail-oriented, and adaptable to a fast-paced, growing environment.

🏖️ Benefits

• Equal Employment Opportunity at Machinify • Commitment to hiring talented and qualified individuals with diverse backgrounds.