Senior Payment Integrity Concept Lead (RN/Coder)

Machinify; United States; Remote; USD 80,000 - 120,000; Full time

Benefits offered by this job

Work from anywhere in the US

Top medical/dental/vision offerings

401(k) with company match

FSA/HSA

Flexible environment

Job summary

Machinify, a leading healthcare intelligence company, seeks a Payment Integrity Concept Development Analyst to lead audit concept development across government and commercial payers. You’ll apply advanced coding knowledge, guide cross-functional teams, and mentor subject matter experts while working remotely across the US.

The role emphasizes policy maintenance, testing, and analytics, with a focus on Medicare and commercial coding rules, clinical criteria, and program-specific payer policies.

Qualifications

• Bachelor's degree or equivalent experience in health administration, nursing, or related field.
• RN or Certified coder credential required (RHIA/RHIT/AHIMA/AAPC or equivalent).
• Minimum 5+ years in healthcare claim type subject matter and audit experience.

Responsibilities

• Lead development, testing, and optimization of payment integrity audit concepts across CMS, Medicaid, and Commercial programs.
• Perform QA reviews and validate concepts against coding guidelines and payer policy.
• Collaborate with clinical, operations, and client services teams to ensure policy accuracy and usability.
• Monitor performance and provide analytics to drive concept improvements and yield.

Skills

Healthcare data analysis

Claims auditing knowledge

Statistical analysis

Communication skills

Remote work ability

Microsoft Excel/PowerPoint

Education

RN license or CPC/CCS/CIC/COC credential

Bachelor's degree in health administration, nursing or related field

Tools

Encoder/Grouper software

Excel

SharePoint/Teams

Job description

Machinify, a leading healthcare intelligence company, seeks a Payment Integrity Concept Development Analyst to lead audit concept development across government and commercial payers. You’ll apply advanced coding knowledge, guide cross-functional teams, and mentor subject matter experts while working remotely across the US.

The role emphasizes policy maintenance, testing, and analytics, with a focus on Medicare and commercial coding rules, clinical criteria, and program-specific payer policies.