Remote Senior Healthcare Data Mining Analyst: Reimbursement

Rawlings Company; La Grange (KY); Remote; USD 125,000 - 135,000; Full time

Benefits offered by this job

Remote-friendly

Medical/Dental/Vision

FSA/HSA

Tuition reimbursement

401(k) with match

Wellness benefits

Flexible work environment

Job summary

Machinify, a leading healthcare intelligence company, seeks a Senior Analyst to advance reimbursement concepts and payment integrity across payer contracts. This hands-on role focuses on claims data, identifying improper payments, and translating policy into actionable analytics.

You'll collaborate with engineering and data science to operationalize findings, maintain CMS and payer guidance expertise, and contribute to process improvements in a fast-paced, digital-first environment.

Qualifications

• 5+ years of experience in healthcare data mining or claims editing.
• Deep understanding of provider contracts, rate structures, 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; connect policy, data, and contractual details.
• Comfortable collaborating with technical teams to guide implementation of business logic.
• Self-directed, detail-oriented, and adaptable to a fast-paced environment.
• Coding certification (e.g., CPC, CCS, or equivalent) preferred.
• Working proficiency in SQL for data exploration and validation.
• Experience in cross-functional R&D or innovation teams focused on healthcare payment integrity.

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.
• Research and document emerging reimbursement and contract patterns, coverage rules, and billing practices to inform concept development.
• Translate complex reimbursement and contract scenarios into structured rules and business logic for implementation.
• 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

Analytical reasoning

Cross-functional collaboration

Detail-oriented

Tools

SQL

Job description

Machinify, a leading healthcare intelligence company, seeks a Senior Analyst to advance reimbursement concepts and payment integrity across payer contracts. This hands-on role focuses on claims data, identifying improper payments, and translating policy into actionable analytics.

You'll collaborate with engineering and data science to operationalize findings, maintain CMS and payer guidance expertise, and contribute to process improvements in a fast-paced, digital-first environment.