New Content Innovation, Claims Editing (Multiple Levels) (Fully Remote)

Machinify; United States; Remote; USD 110,000 - 160,000; Full time

Job summary

Machinify is a healthcare intelligence company that uses an AI-powered platform to maximize financial outcomes and reduce healthcare costs for health plans. Deployed by over 85 health plans representing more than 270 million lives, it fosters a culture of innovation, transparency, and efficiency.

We are seeking a Senior Claims Content Editor who will source and edit content, collaborate with Product and Data Science, and drive measurable improvements in content quality and client value.

Qualifications

• 7+ years in claims editing, clinical coding, Payment Integrity, or payer policy.
• Active coding credential such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license with deep coding knowledge.
• Strong analytical skills using SQL or Excel, and clear communication for both clinical and nonclinical audiences.

Responsibilities

• Source and author editing content, monitoring authoritative sources like CPT, HCPCS, ICD-10-CM, NCCI, and CMS manuals.
• Use claims data to test editing concepts, size opportunities, and track metrics like hit rate, false positives, and savings.
• Partner with Product and Data Science to translate content into requirements and apply AI tools to improve content building.

Skills

Claims editing

Clinical coding

Payment Integrity

Payer policy

SQL

Excel

Communication

AI tools

Education

CPC/CCS/CCS-P/CPMA/CIC or clinical license

Tools

AI platforms

Job description

• Source and author editing content, monitoring authoritative sources like CPT, HCPCS, ICD-10-CM, NCCI, and CMS manuals.
• Use claims data to test editing concepts, size opportunities, and track metrics like hit rate, false positives, and savings.
• Partner with Product and Data Science to translate content into requirements and apply AI tools to improve content building.

What You Bring:

• 7+ years in claims editing, clinical coding, Payment Integrity, or payer policy, with hands-on editing experience.
• Active coding credential such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license with deep coding knowledge.
• Strong analytical skills using SQL or Excel, and clear communication for both clinical and nonclinical audiences.

What Success Looks Like:

• In the first 90 days, learn Machinify's content portfolio and deliver your first validated content updates.
• Within 6-12 months, own a content domain end to end, move data-validated concepts to production, and show measurable improvements in edit accuracy and client value.

Machinify

Machinify is a healthcare intelligence company that uses an AI-powered platform to maximize financial outcomes and reduce healthcare costs for health plans. Deployed by over 85 health plans representing more than 270 million lives, it fosters a culture of innovation, transparency, and efficiency.