Senior Healthcare Data Analyst

🕒 September 25

🇺🇸 United States – Remote

💵 $140k - $170k / year

⏰ Full Time

🟠 Senior

📉 Data Analyst

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👻 Ghost score 21%

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Machinify

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 $10M Series A - Machinify on 2018-10

Healthcare • Consulting • Logistics

Machinify is a healthcare-focused AI platform and services company that reshapes healthcare payments and payment integrity. Its AI operating system unifies claims, medical records, contracts, and policies, and uses foundation models and task-specific agents to automate and improve coding, payment accuracy, recoveries, and cost avoidance. Machinify serves health plans (including 18 of the top 20), supports insourced, hybrid, or fully-managed deployments, and emphasizes measurable outcomes — reporting 85+ customers, 270M member lives covered, and $6B+ in annual cost avoidance and recoveries.

📋 Description

• Design and implement transformations converting raw medical and institutional claims (837 EDI, UB-04, CMS-1500) into canonical models using healthcare coding standards. • Perform data-quality audits and troubleshoot accuracy and completeness issues. • Write SQL and Spark SQL queries to validate pipeline output end-to-end. • Develop deep knowledge of the platform from data ingestion through claims adjudication. • Identify overpayment patterns, COB issues, and billing-edit opportunities using payer policy, CMS regulations, and reimbursement methodologies. • Drive AI adoption by prompting and iterating with LLMs, identifying automation opportunities, and contributing to AI-assisted pipeline development. • Support onboarding of new client data feeds and document transformation logic and lineage. • Partner with data engineers, data scientists, clinical staff, and product managers on scalable data solutions and advanced analytics/ML use cases. • Serve as the subject-matter expert on claims coding, adjudication rules, and payer policy; mentor analysts and engineers and advise stakeholders on risk, trends, and business impact.

🎯 Requirements

• Bachelor's degree in Business, Computer Science, Health Informatics, or a related field. • 5+ years working directly with healthcare claims data — 837 EDI, encounter data, medical billing — ideally at a health plan, payment integrity vendor, or healthcare analytics firm. • Deep knowledge of professional and institutional claim types, ICD-10-CM/PCS, CPT, HCPCS, UB-04, and CMS-1500. • Hands-on payment integrity experience: overpayment detection, COB, billing edits, or claim editing logic. • Familiarity with CMS regulations and commercial payer guidelines. • Advanced SQL proficiency and ability to write complex analytical queries against large datasets. • Solid understanding of data modeling concepts and analytics best practices. • Ability to discuss healthcare processes and payment logic with health plan clients, clinicians, and non-technical stakeholders. • Ability to manage multiple concurrent initiatives. • Preferred: working knowledge of provider reimbursement methodologies; proficiency with Spark SQL or a comparable distributed query engine; exposure to ETL/ELT pipeline development or pipeline design; exposure to value-based care arrangements or risk adjustment (HCC coding, RADV).

🏖️ Benefits

• Work from anywhere in the US • Full Medical/Dental/Vision for employees & their families • Flexible and trusting environment • Unlimited FTO • Competitive salary • Equity/private equity • 401(k) including employer match • Excellent healthcare • Flexible time off • Other benefits and perks

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