Content Innovation, Claims Editing - NY Medicaid (Multiple Levels)

OpenKrill; United States; Remote; USD 135,000 - 165,000; Full time

Job summary

Machinify is seeking a Content Innovation, Claims Editing - NY Medicaid to source, design, validate, and maintain clinical and coding content powering our editing products. The role focuses on New York State Medicaid, translating complex rules into precise edits while ensuring traceability and quality.

You will collaborate with Product and Data Science, leverage data to measure impact, and drive content that improves accuracy and client value.

Qualifications

• Deep clinical editing and coding expertise.
• Strong analytical instinct and AI interest.
• Evidence-driven approach to edits.

Responsibilities

• Monitor and interpret sources such as CPT, HCPCS updates, ICD-10-CM guidelines, NCCI PTP and MUE tables, CMS manuals, NCDs and LCDs, 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 so it is traceable and maintainable.
• Separate portable, market-wide content from client-specific policy, and flag the difference clearly in all content and sizing work.
• Maintain content through quarterly code updates, policy changes, and performance reviews, and recommend refinements or retirements.
• Monitor New York Medicaid sources and translate reimbursement rules into editing logic.
• Build content for programs and provider types that matter to New York plans.
• Track policy changes and keep content current.
• Use claims data to test editing concepts, size opportunities, and estimate savings.
• Review edit output to confirm edits fire as intended and identify gaps or overreach.
• Bring a value-first, analytical view to prioritization and client impact.
• Collaborate with Product and Data Science to turn concepts into requirements and test cases.
• Explain rationale and sources to clients and internal teams.

Job description

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

About the Opportunity

Machinify is redefining Payment Integrity through smarter technology, richer data, and intelligent automation. We are seeking a claims editing content expert to help build the next generation of editing content and make healthcare payments more accurate and affordable. This role will bring deep expertise in New York State Medicaid.

As Content Innovation, Claims Editing - NY Medicaid you will source, design, validate, and maintain the clinical and coding content that powers our editing products. You will find opportunities in policy and in the data, turn them into edits that hold up, and measure whether they deliver value for our health plan clients. Your focus will be New York State Medicaid, where you will be our go-to expert on state policy and how it shapes editing.

This is a build-and-scale role at the intersection of clinical editing, coding, reimbursement policy, data science, and product development. The ideal candidate brings deep clinical editing and coding expertise, a strong analytical instinct, and an open, practical interest in how AI can help us build better content, faster, while keeping quality and clinical accuracy at the center.

You do not need to be a data scientist. You do need to think in terms of evidence, measurable outcomes, and the value each edit creates for a client.

What you’ll do

Source and author editing content

• - 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 so it is traceable, defensible on appeal, and easy to maintain.
• - Separate portable, market-wide content from client‑specific policy, and flag the difference clearly in all content and sizing work.
• - Maintain existing content through quarterly code updates, policy changes, and performance reviews, and recommend when edits should be refined or retired.

Bring depth in New York State Medicaid

• - Monitor and interpret New York Medicaid sources, including eMedNY provider manuals and fee schedules, NYS DOH Medicaid Update, Medicaid Managed Care contract requirements, and OMIG guidance.
• - Translate New York reimbursement rules, including APG and APR‑DRG methodologies, into editing logic, alongside federal Medicaid NCCI PTP and MUE edits.
• - Build content for the programs and provider types that matter most to New York plans, such as Mainstream Managed Care, HARP, behavioral health, FQHC, and long‑term care services.
• - Track New York policy changes and keep state content current.

Validate content with data

• - Use claims data to test editing concepts before build, size the opportunity, and estimate hit rate, false‑positive rate, and savings.
• - Review edit output and production results to confirm edits fire as intended and to find gaps, over‑reach, or missed opportunities.
• - Track measures such as accuracy, hit rate, false positives, appeals, overturns, provider abrasion, and realized savings.
• - Bring an analytical, value‑first view to prioritization: what is the opportunity, how confident are we, and what will it return for the client?

Partner with Product and Data Science

• - Work with Product, Engineering, and Data Science to turn content concepts into clear requirements, logic specifications, and test cases.
• - Help data scientists understand clinical and coding context so models and analyses reflect how care is delivered and billed. Bring Medicaid benefit, eligibility, and billing context to that work.
• - Evaluate where AI tools, including large language models, can speed up policy research, concept discovery, content authoring, and quality review.
• - Apply expert judgment to AI‑generated content and help define the review standards that keep it accurate.

Support clients and internal teams

• - Explain the rationale, sources, and expected impact behind editing content to client and internal audiences.
• - Support client policy review, edit approval, and appeals with clear, well‑sourced documentation.
• - Bring client feedback and operational findings back into the content roadmap.

What Success Looks Like…

First 90 Days

You will learn Machinify’s content portfolio, source library, technology, and development process; build working relationships with Product and Data Science; assess current New York Medicaid coverage against state policy; and deliver a prioritized list of New York content gaps and opportunities.

Within 6 to 12 months

You will own a content domain end to end, move multiple data‑validated concepts into production, maintain accurate and current source documentation, contribute to at least one AI‑assisted improvement in how content is built, set up a repeatable process for tracking New York policy changes, and show measurable results in edit accuracy, speed, or client value.

Pay range: $135,000 - $165,000 USD

This exempt position. The salary range is for Base Salary.Compensation will be determined based on several factors including, but n