Senior Healthcare Data Analyst

machinifyinc; USA; Remote; USD 140.000 - 170.000; Vollzeit

Benefits dieser Stelle

Fully remote role

Medical, dental, vision coverage for员工

Unlimited flexible time off

Equity and 401(k) with employer match

Zusammenfassung

machinifyinc is seeking a Senior Data Analyst to work on healthcare claims within an AI-driven payment integrity platform. You will translate raw claims feeds into canonical data models and surface insights that improve how health plans audit and adjudicate claims.

The role bridges domain expertise with data engineering, requiring deep healthcare data knowledge and familiarity with modern AI tooling. Fully remote in the US is possible.

Qualifikationen

• Bachelor's degree in Business, Computer Science, Health Informatics, or a related field.
• 5+ years working directly with healthcare claims data (837 EDI, encounter data, medical billing).
• Deep knowledge of professional and institutional claim types, ICD-10-CM/PCS, CPT, HCPCS, and standard form formats (UB-04, CMS-1500).
• Hands-on payment integrity experience such as overpayment detection, coordination of benefits, billing edits, or claim editing logic.
• Familiarity with CMS regulations and commercial payer guidelines as they apply to claims adjudication and payment policy.
• Advanced SQL proficiency with the ability to write complex analytical queries against large datasets, plus solid understanding of data modeling concepts.

Aufgaben

• Design and implement data transformations that convert raw medical and institutional claims into canonical data models.
• Audit pipelines end-to-end to detect, troubleshoot, and resolve data quality issues.
• Develop working knowledge of the claims adjudication platform for traceable analytical solutions.
• Identify overpayment patterns and billing edit opportunities by applying payer policy and CMS regulations.
• Drive AI-assisted workflows by prompting and iterating with large language models to accelerate analysis.

Kenntnisse

Advanced SQL

Spark SQL

Data modeling

Communication

Ausbildung

Bachelor's degree

Tools

Spark SQL

Jobbeschreibung

Role overview

A senior data analyst position focused on healthcare claims within an AI-driven payment integrity platform. The role bridges domain expertise and data engineering, translating raw claims feeds into trusted canonical models and surfacing insights that improve how health plans audit and adjudicate claims. It suits someone who knows healthcare data deeply and wants to pair that knowledge with modern AI tooling.

Responsibilities

• Design and implement data transformations that convert raw medical and institutional claims (837 EDI, UB-04, CMS-1500) into canonical data models, applying ICD-10-CM/PCS, CPT, and HCPCS coding standards throughout.
• Audit pipelines end-to-end to detect, troubleshoot, and resolve data quality issues, writing SQL and Spark SQL queries to validate outputs for accuracy and completeness.
• Develop working knowledge of the claims adjudication platform so that analytical solutions are traceable and aligned with business logic.
• Identify overpayment patterns, coordination of benefits issues, and billing edit opportunities by applying payer policy, CMS regulations, and provider reimbursement methodologies.
• Drive AI-assisted workflows by prompting and iterating with large language models to accelerate analysis, surface automation candidates, and contribute to AI-assisted pipeline development.
• Support onboarding of new client data feeds, documenting transformation logic and lineage to ensure smooth integration.
• Partner with data engineers, data scientists, clinical staff, and product managers to translate complex healthcare requirements into scalable data solutions.

Requirements

• Bachelor's degree in Business, Computer Science, Health Informatics, or a related field.
• 5+ years working directly with healthcare claims data (837 EDI, encounter data, medical billing), ideally at a health plan, payment integrity vendor, or healthcare analytics firm.
• Deep knowledge of professional and institutional claim types, ICD-10-CM/PCS, CPT, HCPCS, and standard form formats (UB-04, CMS-1500).
• Hands-on payment integrity experience such as overpayment detection, coordination of benefits, billing edits, or claim editing logic.
• Familiarity with CMS regulations and commercial payer guidelines as they apply to claims adjudication and payment policy.
• Advanced SQL proficiency with the ability to write complex analytical queries against large datasets, plus solid understanding of data modeling concepts.
• Strong communication skills, with the ability to discuss healthcare process and payment logic with clients, clinicians, and non-technical stakeholders.

Nice to have

• Working knowledge of provider reimbursement methodologies including MS-DRG/APR-DRG pricing, fee schedules, per diem, and capitation.
• Proficiency with Spark SQL or a comparable distributed query engine.
• Exposure to ETL/ELT pipeline development or close collaboration with data engineers on pipeline design.
• Familiarity with value-based care arrangements or risk adjustment such as HCC coding and RADV.

Benefits and work setup

• Fully remote role open to candidates anywhere in the US.
• Full medical, dental, and vision coverage for employees and their families.
• Flexible, trust-based environment with unlimited flexible time off.
• Competitive base salary in the $140,000–$170,000 range plus equity and a 401(k) with employer match.