Senior Content Innovation - Claims Editing (AI-Powered)

Rawlings Company; United States; Remote; USD 135,000 - 165,000; Full time

Benefits offered by this job

PTO and holidays

Health, vision, dental insurance

401(k) with match

Tuition reimbursement

Remote and hybrid work options

Job summary

Machinify is seeking a Content Innovation, Claims Editing expert to source, validate, and maintain clinical and coding content powering our editing products. You will translate policy into precise editing logic and document traceable rationale for each edit.

You will work with Product and Data Science to ensure content is data-driven, accurate, and scalable, leveraging AI tools to accelerate policy research and content creation.

Qualifications

• 7+ years of experience in claims editing, coding, or payer policy.
• Active coding credential (CPC/CCS/CCS-P/CPMA/CIC) or clinical license.
• Deep CPT/HCPCS/ICD-10-CM knowledge and modifiers.
• Understanding of reimbursement methods (fee schedules, DRGs, APCs).
• Experience interpreting CMS manuals, NCDs/LCDs, payer policies.
• Strong analytics with claims data (SQL/Excel).
• Experience with Product/Engineering/Data Science teams.
• Clear written communication of complex coding and logic.
• Curiosity about AI in content work.
• Ability to work in a fast, build-and-scale environment.

Responsibilities

• Source and author editing content from CPT/HCPCS and policy sources.
• Translate coding rules and guidelines into precise editing logic.
• Document rationale and scope for each edit for traceability.
• Flag market-wide vs client-specific content clearly in edits.
• Maintain content with quarterly updates and code changes.

Skills

Claims editing

Coding credential

CPT/HCPCS knowledge

ICD-10-CM knowledge

NCCI/MUE knowledge

Reimbursement methods

SQL/Excel

Cross-functional collab

AI tools curiosity

Clear communication

Tools

SQL

Python

BI tools

Job description

Machinify is seeking a Content Innovation, Claims Editing expert to source, validate, and maintain clinical and coding content powering our editing products. You will translate policy into precise editing logic and document traceable rationale for each edit.

You will work with Product and Data Science to ensure content is data-driven, accurate, and scalable, leveraging AI tools to accelerate policy research and content creation.