Senior Contract Analyst

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🧐 Analyst

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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

• Serve as the single source of truth for payer-provider contracts and reimbursement policies supporting outpatient and specialty audit programs • Validate contract versions, amendments, fee schedules, and effective dates before audits • Build and maintain contract inventory with version control, renewal tracking, and audit trails • Identify missing, expired, or outdated contracts and drive resolution • Review contracts and abstract audit opportunities, including carve-out payments, implant and device provisions, high-cost drug terms, stop-loss and outlier thresholds, lesser-of language, bundling and packaging rules, and exclusions • Translate contract language into documentation auditors can apply consistently • Flag ambiguous or conflicting language and escalate recommended interpretations • Maintain payer reimbursement policy library and monitor policy updates, retirements, and effective-date changes • Identify policy gaps and maintain linkage among concepts, policies, and clients • Maintain the outpatient and specialty concept matrix for each client, including active, paused, or excluded concepts • Establish matrix update cadence, change control, and quality checks • Provide reporting on concept coverage gaps and expansion opportunities • Partner with Client Success teams to obtain updated contracts and policies from clients • Track outstanding client requests through resolution • Communicate contract, policy, and concept changes to audit teams • Identify process improvements and support scaling of contract intake and abstraction workflows

🎯 Requirements

• Bachelor's degree or equivalent professional experience • 5+ years of experience in healthcare payment integrity, provider contracting, managed care, claims auditing, or revenue cycle • Demonstrated ability to read, interpret, and abstract payer-provider contract terms and reimbursement methodologies • Strong working knowledge of outpatient reimbursement, including OPPS/APC, fee schedules, percent of charges, and carve-out structures • Working knowledge of payer reimbursement policies and ability to connect policy language to audit concepts • Familiarity with AI tools such as Claude for contract, policy, and payer research • Advanced Excel skills and experience building and maintaining complex tracking tools or matrices

🏖️ Benefits

• Equal employment opportunity workplace • Employment at will • Reasonable accommodation available during the application or recruitment process • E-Verify participation as required by applicable law