Data Mining Auditor

The Rawlings Group; La Grange (KY); Remote; USD 77,000 - 94,000; Full time

Benefits offered by this job

Work from anywhere in the US

Top Medical/Dental/Vision offerings

FSA/HSA

Tuition reimbursement

401(k) with company match

Additional health and wellness perks

Job summary

Machinify is seeking an Auditor to perform pre- and post-pay data mining for claims audits on behalf of our healthcare clients. The role supports product testing, quality improvements, and customer satisfaction across payer guidelines and CMS requirements.

You will review payments, identify valid claims, and help refine reimbursement policies in a fast-paced setting. Proficiency in Excel, Word, Gmail, Google Sheets, Slack, and related tools is essential.

Qualifications

• 3–5 years of relative experience in healthcare claims auditing or related field.
• Ability to review payment information against Medicare and payer guidelines.
• Experience or certification in coding/billing is helpful.
• Ability to meet deadlines and handle workload demands.
• Strong problem-solving and investigative abilities; attention to detail.

Responsibilities

• Conduct comprehensive reviews of pre and post pay claims using available resources.
• Serve as a claims billing and payment expert for data teams and departments.
• Develop and refine reimbursement policies with the team.
• Stay updated with latest billing guidelines and regulations.
• Ensure accuracy and quality in audit documentation.

Skills

Attention to detail

Problem-solving

Deadline-oriented

Data analysis

Team collaboration

Education

Coding/billing certification

Tools

Excel

Word

Gmail

Google Sheets

Slack

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.

Machinify is seeking an Auditor for pre and/or post pay data mining to conduct claims audits on behalf of Machinify's customers. In addition, the Auditor will assist in product testing, quality enhancements, and related tasks to ensure customer satisfaction.

The ideal person for this role has a strong background in healthcare claims auditing, claims processing and coding, and a high level of understanding of payment guidelines for CMS and commercial payers.

What You'll Do:

• Conduct comprehensive reviews of pre and post pay claims using any and all available resources, including but not limited to, claims data and client adjudication systems, payment guidelines and compliance with regulatory requirements, contract, pricing systems, medical records, authorizations, etc.
• Serve as a claims billing and payment expert, and resource for the data teams and other departments.
• Develop and refine reimbursement policies and procedures in collaboration with the team.
• Remain updated with the latest billing guidelines and regulations.
• Achieve the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation.
• Additional responsibilities as assigned or needed to support the business.

What You Bring:

• 3-5 years of relative experience.
• Ability to review payment information against Medicare and payer billing guidelines to make determinations relating to the appropriateness of payments.
• Experience or certification in coding/billing is helpful.
• Ability to meet deadlines.
• Willingness and ability to do whatever is necessary to accomplish workload demands
• Delivery of high-quality work is critical.
• Strong attention to detail; investigative and deductive reasoning skills are a must.
• Must be able to make decisions and conclusions when working with limited information using reference materials and strong problem-solving skills.
• Must be proficient in Excel, Word, Gmail, Google Sheets, Slack, etc.
• Able to work in a fast-paced environment and adapt to rapid change and growth.

Preferred Experience:

• Post-Pay data mining auditing experience
• Pre-Pay data mining experience
• Payer auditing experience

What We Offer:

• Work from anywhere in the US! Machinify is digital-first.
• Top Medical/Dental/Vision offerings
• FSA/HSA
• Tuition reimbursement
• Competitive salary, 401(k) with company match
• Additional health and wellness benefits and perks
• Flexible and trusting environment where you'll feel empowered to do your best work

The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc.

Pay range: $85,000

Equal Employment Opportunity at Machinify

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/