IBR Policy and Content Development Analyst

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $85k - $110k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

✍️ Content Marketing Manager

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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

• Develop, enhance, and maintain clinical and coding payment integrity solutions. • Review and update audit concepts on regular cycles or in response to client or regulatory changes, including research, data/claim analysis, rule-document updates, and code-list updates. • Research and analyze the impact of regulatory, coding, or payer-policy changes on existing concepts and document findings. • Interpret and apply client-specific payer policies in audit concept reviews and updates. • Embed state-specific Medicare/Medicaid provider manuals and regional regulatory mandates into audit concept configurations. • Evaluate payer policies to identify gaps and propose new audit concepts to clients. • Ensure audit concepts are correctly formulated across Medicaid, Medicare, and Commercial programs. • Align concepts with CMS, MUEs, CPT/HCPCS coding guidelines, and NCCI edits. • Identify discrepancies in concept performance and drive resolution with clinical, coding, and operations teams. • Benchmark concept outcomes against industry standards, historical data, and client baselines. • Test new concepts to verify automated logic before implementation. • Validate concepts against coding guidelines, payment methodologies, and payer policy before deployment. • Ensure consistent policy application across platforms and client programs. • Collaborate with operations, clinical, client services, and IT teams on coding solutions, audit strategies, and payment integrity initiatives. • Improve audit concept workflows, documentation, tracking, and cross-functional coordination. • Use AI tools and automation to optimize policy development, streamline research, and scale solution performance. • Perform additional responsibilities and ad hoc projects as assigned.

🎯 Requirements

• 3+ years’ experience performing payment integrity or auditing facility claims. • Experience translating complex medical regulations and payer guidelines into clear, legally compliant clinical content and structured policy documentation. • Deep understanding of Medicare and Commercial coding rules, regulations, and prospective payment systems. • Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology. • Knowledge of national coding standards, particularly payment rules. • Strong organizational and written communication skills. • In-depth knowledge of diverse facility reimbursement methodologies and commercial/government payment policies to ensure accurate contract compliance and audit integrity. • Proficient in Windows office systems, including the full Microsoft Suits (Excel, Word, Outlook, PowerPoint, SharePoint, and Teams). • Demonstrated experience or proficiency in utilizing AI tools and automation platforms to optimize clinical research. • Proven ability to communicate effectively with all levels of the organization, with diverse teams, and with clients. • Ability to prioritize and multitask. • At least one of the following coding certificates: RHIA, RHIT, CCS, CPC, CPMA. • Or, Active RN/LPN License.

🏖️ Benefits

• Work from anywhere in the US! Machinify is digital-first. • Top Medical/Dental/Vision offerings • FSA/HSA • Tuition reimbursement • Competitive salary • 401(k) with company match • Additional health and wellness benefits and perks • Flexible and trusting environment where you’ll feel empowered to do your best work