Sr. Auditor - Pre/Post pay claim (Remote)

Palo Alto, California, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Software, Artificial IntelligenceIndustries

Requirements

Candidates should have at least 5 years of relative experience in healthcare claims auditing, claims processing, and coding. A strong understanding of payment guidelines for CMS and commercial payers is required, along with the ability to review payment information against Medicare and payer billing guidelines. Proficiency in Excel, Word, Google Sheets, and messaging platforms is essential. Investigative and deductive reasoning skills are a must, along with a strong attention to detail and problem-solving abilities. Experience or certification in coding/billing is helpful, and candidates must be able to work in a fast-paced environment and meet deadlines.

Responsibilities

The Sr. Auditor will conduct comprehensive reviews of pre and post pay claims using available resources, serving as a claims billing and payment expert for data teams and other departments. They will develop and refine reimbursement policies and procedures, remain updated with the latest billing guidelines and regulations, and achieve the expected level of accuracy and quality in audits. Additional responsibilities include identifying new payment error concepts, suggesting and developing high-quality concepts for process improvement, and handling additional tasks as assigned to support the business.

Skills

Healthcare Claims Auditing

Claims Processing

Claims Coding

CMS Payment Guidelines

Commercial Payer Payment Guidelines

Data Mining

Reimbursement Policies

Regulatory Compliance

AI-powered software

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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