[Remote] Senior Analyst (Data mining) at Machinify

Remote

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Healthcare IntelligenceIndustries

Requirements

5+ years experience in healthcare data mining or claims editing on the provider, payer, or vendor side
Deep understanding of provider contracts, including rate structures, carve-outs, and reimbursement methodologies
Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers
Proven ability to identify improper payment patterns, root causes, and opportunities for correction
Strong investigative and deductive reasoning skills; able to connect policy, data, and contractual details
Comfortable working in close collaboration with technical teams to guide implementation of business logic
Self-directed, detail-oriented, and adaptable to a fast-paced, growing environment

Responsibilities

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

Skills

Key technologies and capabilities for this role

ReimbursementPayment IntegrityProvider ContractsClaims Data AnalysisAnalytical FrameworksAutomation Frameworks

Questions & Answers

Common questions about this position

What experience is required for the Senior Analyst role?

Candidates need 5+ years of experience in healthcare data mining or claims editing on the provider, payer, or vendor side, along with deep understanding of provider contracts including rate structures, carve-outs, and reimbursement methodologies.

What key skills are needed for this position?

The role requires strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers, plus proven ability to identify improper payment patterns and strong investigative and deductive reasoning skills.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What is the salary or compensation for this role?

This information is not specified in the job description.

What kind of collaboration is involved in this role?

The role involves close collaboration with engineering and data science teams to translate business and reimbursement logic into analytical and automation frameworks, and comfort working with technical teams.

Machinify

AI-driven solutions for healthcare administration

About Machinify

Machinify provides AI-driven solutions to improve decision-making in the healthcare industry. Its platform helps health plans, payers, and providers optimize their operations, particularly in areas like claims processing and utilization management. The applications offered by Machinify can be quickly deployed, allowing clients to see immediate returns on investment. This focus on rapid implementation sets Machinify apart from competitors, as healthcare organizations increasingly seek cost efficiency and better patient outcomes. The company's goal is to enhance operational efficiency and help clients manage healthcare expenditures more effectively.

Palo Alto, CaliforniaHeadquarters

2016Year Founded

$15.2MTotal Funding

SERIES_ACompany Stage

AI & Machine Learning, HealthcareIndustries

51-200Employees

Benefits

Medical, dental, & vision

Flexible work environment

Generous PTO

Competitive salary

Equity

401(k)

Sponsorship

Generous L&D Reimbursement policy

Risks

Integration challenges with Evolent Health could disrupt Machinify's operations.

Slow adoption of new technologies in healthcare may hinder Machinify's rapid deployment.

Reliance on a few large clients poses a risk if they switch providers.

Differentiation

Machinify leverages AI to optimize healthcare decision-making and administrative processes.

The company offers rapid deployment of AI applications for immediate ROI in healthcare.

Machinify's AI platform addresses the entire healthcare claims lifecycle efficiently.

Upsides

AI-driven automation in healthcare claims processing is gaining significant traction.

The healthcare AI market is projected to reach $45.2 billion by 2026.

Machinify's AI solutions reduce administrative costs and improve patient care access.

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