Senior Healthcare Data Miner: Reimbursement Analytics

Machinify; United States; Remote; USD 125,000 - 135,000; Full time

Benefits offered by this job

Remote work (US)

Medical/Dental/Vision benefits

401(k) with company match

FSA/HSA

Job summary

Machinify, a leading healthcare intelligence company, seeks a Senior Analyst to lead the development and refinement of reimbursement and payment integrity concepts. This hands-on role focuses on claims data, contract terms, and payer rules to shape analytics and automation strategies.

You'll partner with engineering and data science teams to translate policy and contract knowledge into actionable logic, identify overpayments, and ensure accurate payments across CMS and commercial payers.

Qualifications

• 5+ years of experience in healthcare data mining or claims editing.
• Deep understanding of provider contracts and reimbursement methodologies.
• Strong knowledge of CMS and commercial payer rules.
• Ability to identify improper payment patterns and root causes.
• Strong investigative and deductive reasoning skills.
• Comfortable guiding implementation with technical teams.
• Self-directed and detail-oriented in a fast-paced environment.

Responsibilities

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

Skills

Healthcare data mining

Claims editing

Contract interpretation

Problem solving

Analytical thinking

Cross-functional collaboration

Deductive reasoning

Education

CPC/CCS certification

Tools

SQL

Job description

Machinify, a leading healthcare intelligence company, seeks a Senior Analyst to lead the development and refinement of reimbursement and payment integrity concepts. This hands-on role focuses on claims data, contract terms, and payer rules to shape analytics and automation strategies.

You'll partner with engineering and data science teams to translate policy and contract knowledge into actionable logic, identify overpayments, and ensure accurate payments across CMS and commercial payers.