Content Innovation: Specialty Pharmacy Claims Editor

Machinify; United States; Teletrabalho; USD 135 000 - 165 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

PTO

Paid Holidays

Volunteer Days

Health insurance

Vision coverage

Dental coverage

401(k) match

Flexible spending accounts

Tuition reimbursement

Life insurance

Short-term disability

Parental leave

Remote/hybrid options

Resumo da oferta

Machinify seeks a Content Innovation, Claims Editing specialist focused on Specialty Pharmacy. You will source, design, validate, and maintain clinical and coding content for high-cost drugs billed under medical benefits. Expect to work across policy, data science, and product to scale content quickly with accuracy.

You will build edits for HCPCS, NDC-HCPCS crosswalks, dosing, and drug modifiers, tracking label changes and updates while ensuring compliance and client value.

Qualificações

• 7+ years of experience in claims editing, clinical coding, or payer policy with hands-on edit authoring/validation.
• Active coding credential (CPC/CCS/CPMA) or clinical license (RN) with deep coding experience.
• Deep knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI, MUEs, guidelines, and documentation.

Responsabilidades

• Source, author, and edit content for specialty pharmacy and high-cost drugs.
• Translate coding rules and reimbursement policy into precise editing logic.
• Document sources and rationale for each edit for traceability and maintenance.

Conhecimentos

Claims editing

Clinical coding

Payer policy

CPC/CCS/CPMA

RN/licensed clinician

CPT/HCPCS knowledge

SQL/Excel

Cross-functional

AI interest

Healthcare content

Formação académica

Pharmacy degree (PharmD/RPh)

Ferramentas

Python

BI tools

SQL

Descrição da oferta de emprego

Machinify seeks a Content Innovation, Claims Editing specialist focused on Specialty Pharmacy. You will source, design, validate, and maintain clinical and coding content for high-cost drugs billed under medical benefits. Expect to work across policy, data science, and product to scale content quickly with accuracy.

You will build edits for HCPCS, NDC-HCPCS crosswalks, dosing, and drug modifiers, tracking label changes and updates while ensuring compliance and client value.