Remote Senior Healthcare Data Miner – Reimbursement

Machinify; EUA; Teletrabalho; USD 125 000 - 135 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Remote nationwide

Competitive salary with 401(k) match

Medical/Dental/Vision insurance

Tuition reimbursement

Resumo da oferta

Machinify is seeking a Senior Analyst to lead the development of reimbursement and payment integrity concepts. This role focuses on understanding payment policies, provider contracts, and how to translate that expertise into analytics and automation within a healthcare data context.

You will analyze claims, review contracts, and collaborate with engineering and data science teams to implement structured business logic and detect improper payments.

Qualificações

• 5+ years of experience in healthcare data mining or claims editing.
• Deep understanding of provider contracts, including rate structures and reimbursement methodologies.
• Knowledge of CMS and commercial payer payment rules and guidelines.
• Ability to translate policy, data, and contracts into actionable logic for analytics and automation.
• Experience partnering with engineering/data science teams to operationalize business logic.

Responsabilidades

• Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise.
• Analyze provider contracts to ensure payments align with negotiated terms, methodologies, and payer rules.
• Collaborate with engineering and data science teams to translate business and reimbursement logic into analytical and automation frameworks.
• Research and document emerging reimbursement and contract patterns to inform concept development.
• Translate complex reimbursement scenarios into structured rules for implementation.
• Analyze claim-level data to pinpoint root causes of overpayments or wrong denials and suggest corrective actions.
• Maintain expertise on CMS and commercial payer reimbursement guidelines.
• Support quality review, concept validation, and process improvement initiatives.

Conhecimentos

Healthcare data mining

Claims editing

Contract analysis

Reimbursement logic

Cross-functional collaboration

SQL

Ferramentas

SQL

Descrição da oferta de emprego

Machinify is seeking a Senior Analyst to lead the development of reimbursement and payment integrity concepts. This role focuses on understanding payment policies, provider contracts, and how to translate that expertise into analytics and automation within a healthcare data context.

You will analyze claims, review contracts, and collaborate with engineering and data science teams to implement structured business logic and detect improper payments.