Senior Claims Editing & Content Innovation Lead

OpenKrill; United States; On-site; USD 135,000 - 165,000; Full time

Benefits offered by this job

PTO and Holidays

Health, Vision & Dental coverage

401(k) with company match

Tuition reimbursement

Life insurance & short-term disability

Parental leave

Remote and hybrid work options

Job summary

Machinify seeks a Content Innovation, Claims Editing expert to source, design, and maintain clinical and coding content powering editing products. You’ll turn policy and data into testable edits and measure value for health plan clients.

Ideal candidates bring deep clinical editing and coding expertise, strong analytical instincts, and a practical interest in AI-driven content improvements while maintaining quality and accuracy.

Qualifications

• 7+ years in claims editing, clinical coding, or payer policy with edits.
• Active coding credential or clinical license with deep coding experience.
• Deep knowledge of CPT/HCPCS/ICD-10-CM and NCCI/MUEs.
• Familiarity with reimbursement methodologies and payer policies.
• Ability to work with cross-functional teams.

Responsibilities

• Source and author editing content from CPT/HCPCS, ICD-10-CM, NCCI, CMS.
• Translate coding rules into precise, testable edits and document rationale.
• Maintain content through quarterly updates and policy changes.
• Validate edits with claims data; measure accuracy and savings.
• Collaborate with Product, Engineering, Data Science on requirements.
• Explain content rationale to clients and internal teams.

Skills

Claims editing

Clinical coding

Payment Integrity

Payer policy

Data interpretation

Communication to nonclinical audiences

Education

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

Tools

SQL

Excel

Python

Job description

Machinify seeks a Content Innovation, Claims Editing expert to source, design, and maintain clinical and coding content powering editing products. You’ll turn policy and data into testable edits and measure value for health plan clients.

Ideal candidates bring deep clinical editing and coding expertise, strong analytical instincts, and a practical interest in AI-driven content improvements while maintaining quality and accuracy.