Content Innovation: NY Medicaid Claims Editor

Machinify; United States; Remote; USD 120,000 - 160,000; Full time

Job summary

Machinify seeks an experienced Content Innovation, Claims Editing specialist focused on New York Medicaid to source, design, validate, and maintain clinical and coding content for editing products. You will transform policy into precise edits and measure value for health plan clients in a largely remote role.

The ideal candidate has deep editing/coding expertise, a robust analytical mindset, and a proactive stance on using AI to speed content authoring while preserving clinical accuracy.

Qualifications

• 7+ years in claims editing or payer policy with hands-on edit authoring/validation.
• Active coding credential (CPC/CCS/CCS-P/CPMA/CIC) or a clinical license (RN).
• Deep CPT/HCPCS/ICD-10-CM knowledge, NCCI, MUEs, and coding guidelines.
• Experience with reimbursement methodologies including fee schedules, DRGs, APCs.
• Sourcing and interpreting CMS manuals, NCDs/LCDs, AMA guidance, and payer policies.
• Strong analytical skills; comfortable with claims data using SQL/Excel to test hypotheses.

Responsibilities

• Source and author editing content from authoritative sources such as CPT/HCPCS, ICD-10-CM, NCCI, and CMS manuals.
• Translate coding rules and reimbursement policy into precise, testable editing logic.
• Document source, rationale, and scope for every edit; ensure traceability and maintainability.
• Maintain content through quarterly updates and policy changes; flag when edits should be refined.
• Limit client-specific policy to separate portable, market-wide content and clearly flag differences.
• Monitor NY Medicaid sources (eMedNY, NYS DOH updates, OMIG guidance) and NY APGs/APR-DRGs rules.

Skills

Analytical skills

SQL

Excel

Communication

AI curiosity

Team collaboration

Education

CPC / CCS / CCS-P / CPMA / CIC

RN or equivalent clinical license

Tools

SQL

Excel

BI tools

Job description

Machinify seeks an experienced Content Innovation, Claims Editing specialist focused on New York Medicaid to source, design, validate, and maintain clinical and coding content for editing products. You will transform policy into precise edits and measure value for health plan clients in a largely remote role.

The ideal candidate has deep editing/coding expertise, a robust analytical mindset, and a proactive stance on using AI to speed content authoring while preserving clinical accuracy.