Healthcare Reimbursement Data Analyst

Rawlings Company; La Grange (KY); Remote; USD 80,000 - 90,000; Full time

Benefits offered by this job

Work from anywhere in the US

Medical/Dental/Vision benefits

FSA/HSA

Tuition reimbursement

401(k) with company match

Wellness benefits

Job summary

Machinify, a leading healthcare intelligence company, seeks an Analyst to develop and refine reimbursement concepts. This is a hands-on, non-technical role focused on understanding provider contracts, payor rules, and payment logic to inform analytics and automation.

You will analyze claims data to identify error patterns, partner with engineering and data science to operationalize solutions, and stay current with CMS and commercial payer guidelines. Remote-friendly across the US.

Qualifications

• 2+ years of experience in healthcare data mining or claims editing on the provider, payer, or vendor side.
• Deep understanding of provider contracts, including rate structures, carve-outs, and reimbursement methodologies.
• Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers.
• Proven ability to identify improper payment patterns, root causes, and opportunities for correction.
• Strong investigative and deductive reasoning skills; able to connect policy, data, and contractual details.
• Comfortable working in close collaboration with technical teams to guide implementation of business logic.
• Self-directed, detail-oriented, and adaptable to a fast-paced, growing environment.

Responsibilities

• Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise.
• Analyze and interpret provider contracts to ensure payments align with negotiated terms, methodologies, and payer rules.
• Collaborate closely with engineering and data science teams to translate business and reimbursement logic into analytical and automation frameworks.
• Analyze claim-level data to pinpoint root causes of overpayments or incorrect denials and recommend corrective approaches.
• Maintain expertise on CMS and commercial payer reimbursement guidelines.
• Support quality review, concept validation, and process improvement initiatives.

Skills

Healthcare data mining

Claims editing

Provider contracts

CMS guidelines

Payor rules

Analytical reasoning

Collaboration with tech teams

Attention to detail

Job description

Machinify, a leading healthcare intelligence company, seeks an Analyst to develop and refine reimbursement concepts. This is a hands-on, non-technical role focused on understanding provider contracts, payor rules, and payment logic to inform analytics and automation.

You will analyze claims data to identify error patterns, partner with engineering and data science to operationalize solutions, and stay current with CMS and commercial payer guidelines. Remote-friendly across the US.