Content Innovation, Claims Editing

🔥 6 minutes ago

🇺🇸 United States – Remote

💵 $135k - $165k / year

⏰ Full Time

🟠 Senior

🔴 Lead

✍️ Content Marketing Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• 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 • Separate portable market-wide content from client-specific policy • Maintain content through code updates, policy changes, and performance reviews; recommend refinements or retirement • Use claims data to test editing concepts, size opportunities, and estimate hit rate, false-positive rate, and savings • Review edit output and production results to identify gaps, over-reach, and missed opportunities • Track accuracy, hit rate, false positives, appeals, overturns, provider abrasion, and realized savings • Partner with Product, Engineering, and Data Science on requirements, logic specifications, and test cases • Help data scientists understand clinical and coding context • Evaluate AI tools, including large language models, for research, discovery, authoring, and quality review • Apply expert judgment to AI-generated content and define review standards • Explain content rationale, sources, and expected impact to clients and internal audiences • Support client policy review, edit approval, and appeals • Bring client feedback and operational findings into the content roadmap • Learn Machinify’s content portfolio, source library, technology, and development process • Own a content domain end to end and move data-validated concepts into production

🎯 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 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 • Experience at a claims editing, Payment Integrity, or healthcare technology company preferred • Experience across commercial, Medicare Advantage, and Medicaid lines of business preferred • Clinical background with direct patient care experience preferred • Experience writing product requirements or logic specifications preferred • Experience with Python, SQL, or BI tools for claims analysis preferred • Experience presenting content rationale or savings analyses to health plan clients preferred

🏖️ Benefits

• PTO, Paid Holidays, and Volunteer Days • Eligibility for health, vision and dental coverage • 401(k) plan participation with company match • Flexible spending accounts • Tuition Reimbursement • Company-paid life insurance • Company-paid short-term disability • Company-paid parental leave • Remote and hybrid work options