Payment Integrity Concept Lead (RN/Coder)

Rawlings Company

La Grange (KY)

Remote

USD 80,000 - 120,000

Full time

14 days+

A complete application in a minute

Tailored resume and cover letter, ready to send.

Get past ATS filters

Benefits offered by this job

Work from anywhere in the US

Top Medical/Dental/Vision

Tuition reimbursement

401(k) with company match

Flexible and empowering environment

Job summary

Machinify is a leading healthcare intelligence company delivering value and efficiency to health plans nationwide. The Concept Development Analyst role leads the creation and optimization of payment integrity audit concepts, working with cross-functional teams to ensure accuracy and regulatory alignment.

The ideal candidate has deep healthcare coding knowledge, 5+ years in payment integrity, and RN or CPC/CCS/CIC/COC credentials.

Qualifications

Bachelor's degree or equivalent experience in health administration, business, nursing, or related field.
Minimum 5+ years in healthcare claim type subject matter specialty, including payment integrity and claims auditing.
Equivalent 3+ years in claims auditing and recovery auditing.
Registered Nurse or Certified Coder with a recognized credential required.

Responsibilities

Develop, maintain, test, and optimize payment integrity audit concepts across CMS, Medicaid, and Commercial programs.
QA reviews of audit concepts ensuring regulatory and coding changes are applied timely.
Lead cross‑functional collaboration with operations, clinical, client services, and technology teams.
Mentor and oversee a team of subject matter experts in audit concept development.
Provide client support and expert feedback to improve policy usability and accuracy.