Senior Analyst - Reimbursement and Payment Integrity (Remote)

About the Role

Machinify is seeking a Senior Analyst - Reimbursement and Payment Integrity to join our team in a fully remote capacity. As a Senior Analyst, you will play a crucial role in leading the development and refinement of reimbursement and payment integrity concepts. This position is ideal for someone with a deep understanding of reimbursement logic, payment policies, and provider contracts, who can translate that expertise into actionable insights. You will work closely with technical teams to operationalize your findings, making this a pivotal role in enhancing our healthcare intelligence capabilities.

What You’ll Do

• 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.

Requirements

• 5+ years of 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 the implementation of business logic.
• Self-directed, detail-oriented, and adaptable to a fast-paced, growing environment.

Nice to Have

• Coding or billing certifications.
• Working proficiency in SQL for data exploration and validation.
• Prior work in cross-functional R&D or innovation teams focused on healthcare payment integrity.

What We Offer

• Work from anywhere in the US! Machinify is digital-first.
• Top Medical/Dental/Vision offerings.
• FSA/HSA.
• Solid PTO program.
• Tuition reimbursement.
• Competitive salary, 401(k) with company match.
• Additional health and wellness benefits and perks.
• Flexible and trusting environment where you’ll feel empowered to do your best work.