Innovative NY Medicaid Claims Editor

OpenKrill; United States; Vor Ort; USD 135.000 - 165.000; Vollzeit

Zusammenfassung

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.

Qualifikationen

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

Aufgaben

• 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.

Jobbeschreibung

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.