Senior Healthcare Data Analyst

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $140k - $170k / year

⏰ Full Time

🟠 Senior

📉 Data 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

• Design and implement transformations converting raw medical and institutional claims into Machinify’s canonical models • Apply healthcare coding standards throughout claims transformation • Audit, troubleshoot, and resolve data-quality and completeness issues • Write SQL and Spark SQL queries to validate pipeline output end-to-end • Develop expertise in Machinify’s platform from data ingestion through claims adjudication • Identify overpayment patterns, coordination-of-benefits issues, and billing-edit opportunities • Apply payer policy, CMS regulations, and provider reimbursement methodologies • Drive AI adoption by prompting and iterating with LLMs • Identify manual processes suitable for automation and contribute 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 • Collaborate with data scientists on advanced analytics and machine-learning use cases • Serve as 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, including 837 EDI, encounter data, or medical billing • Deep knowledge of professional and institutional claim types, ICD-10-CM/PCS, CPT, HCPCS, UB-04, and CMS-1500 • Hands-on payment integrity experience, including overpayment detection, COB, billing edits, or claim editing logic • Familiarity with CMS regulations and commercial payer guidelines for claims adjudication and payment policy • 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 process and payment logic with health plan clients, clinicians, and non-technical stakeholders • Ability to manage multiple concurrent initiatives with strong ownership and accountability • Preferred: Working knowledge of provider reimbursement methodologies, including MS-DRG/APR-DRG pricing, fee schedules, per diem, and capitation • Preferred: Proficiency with Spark SQL or a comparable distributed query engine • Preferred: Exposure to ETL/ELT pipeline development or data-engineering collaboration • Preferred: Exposure to value-based care arrangements or risk adjustment, including HCC coding and RADV

🏖️ Benefits

• Work from anywhere in the US; digital-first workplace • Full Medical/Dental/Vision for employees and their families • Flexible and trusting environment • Unlimited FTO • Equity/private equity • 401(k) including employer match • Flexible time off and other benefits and perks