Sr. Auditor - Prepay, Postpay Data Mining

Machinify is the leading provider of AI-powered software products that transform healthcare claims and payment operations. Each year, the healthcare industry generates over $200B in claims mispayments, creating incredible waste, friction and frustration for all participants: patients, providers, and especially payers. Machinify’s revolutionary AI-platform has enabled the company to develop and deploy, at light speed, industry-specific products that increase the speed and accuracy of claims processing by orders of magnitude.

Machinify is seeking a Sr. Auditor for pre and/or post pay data mining to conduct claims audits on behalf of Machinify’s customers. In addition, the Sr. Auditor will assist in concept ideation, product testing, quality enhancements, and related tasks to ensure customer satisfaction.

The ideal person for this role has a strong background in healthcare claims auditing, claims processing and coding, and a high level of understanding of payment guidelines for CMS and commercial payers.

Responsibilities/Impact:

• Conduct comprehensive reviews of pre and post pay claims using any and all available resources, including but not limited to, claims data and client adjudication systems, payment guidelines and compliance with regulatory requirements, contract, pricing systems, medical records, authorizations, etc.  

• Serve as a claims billing and payment expert, and resource for the data teams and other departments. 

• Develop and refine reimbursement policies and procedures in collaboration with the team. 

• Remain updated with the latest billing guidelines and regulations.

• Achieve the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation.

• Additional responsibilities as assigned or needed to support the business.

• Identify new payment error concepts. Identifies potential claims outside of the concept where additional recoveries may be available. Suggests and develops high-quality, high-value concepts and or process improvement, tools, etc.
  

Required Skills and Qualifications:

• 5+ years of relative experience

• Ability to review payment information against Medicare and payer billing guidelines to make determinations relating to the appropriateness of payments

• Experience or certification in coding/billing is helpful

• Ability to meet deadlines

• Willingness and ability to do whatever is necessary to accomplish workload demands

• Delivery of high-quality work is critical

• Strong attention to detail; investigative and deductive reasoning skills are a must

• Must be able to make decisions and conclusions when working with limited information using reference materials and strong problem-solving skills

• Proficiency in Excel, Word, Google Sheets, Slack/messaging platform, etc.

• Able to work in a fast paced environment and adapt to rapid change and growth.

Preferred skills:

• Data Mining experience - Post and Pre-pay

• Payer auditing experience

• Coding certification

What we offer:

• Work from anywhere in the US! Our team is distributed and most of us work from home

• A flexible and trusting environment where you'll feel empowered to do your best work

• Hardworking and supportive colleagues and a leadership team that understands the importance of recruiting and retaining top talent

• Incredible Medical/Dental/Vision benefits for employees & their families.

• Competitive salary and equity, 401(k) sponsorship, life insurance

• Generous Learning and Development Reimbursement policy

The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc.

Our Recruiting team will let you know if you qualify for a different role/range. Salary is one component of the total compensation package, which includes excellent healthcare, flexible time off, and other benefits and perks.

Equal Employment Opportunity at Machinify

Machinify is committed to hiring talented and qualified individuals with diverse backgrounds for all of its positions. Machinify believes that the gathering and celebration of unique backgrounds, qualities, and cultures enriches the workplace.