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Machinify
Machinify
1,001 – 5,000 कर्मचारी
H1B वीज़ा प्रायोजकपरामर्शलॉजिस्टिक्सस्वास्थ्य सेवा
Machinify एक हेल्थकेयर एआई प्लेटफ़ॉर्म और सेवा कंपनी है, जिसका ध्यान स्वास्थ्य योजनाओं के लिए भुगतान की शुद्धता बेहतर बनाने पर है। इसका एआई ऑपरेटिंग सिस्टम दावों, चिकित्सा अभिलेखों, अनुबंधों और नीतियों को एक साथ लाता है तथा फाउंडेशन मॉडल और कार्य-विशिष्ट एजेंटों को मिलाकर कोडिंग, भुगतान की सटीकता, वसूली और लागत से बचाव में सहायता करता है। Machinify इनसोर्स्ड, हाइब्रिड और पूरी तरह प्रबंधित परिनियोजन विकल्प प्रदान करती है। यह 85 से अधिक ग्राहकों को सेवा देती है और 270 मिलियन सदस्य जीवनों को कवर करती है। कंपनी के अनुसार, वह हर वर्ष 6 अरब डॉलर से अधिक की लागत बचत और वसूली हासिल करती है।
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कंपनी की नौकरियाँ

Post-Acute Services Audit Policy Analyst

Develops and refines payment integrity audits for durable medical equipment, home health, and home infusion claims at Machinify. The role evaluates policy compliance, validates audit concepts, analyzes claims, and supports clients.

USसंयुक्त राज्यरिमोटपूर्णकालिकमध्य स्तरवरिष्ठआवश्यक भाषा: अंग्रेज़ीविश्लेषक

विवरण

  • Serve as a subject matter expert on durable medical equipment, home health, and home infusion claims across government and commercial programs.
  • Develop, maintain, test, and refine post-acute payment integrity audit concepts.
  • Coordinate with operations, clinical, client services, and technology teams to align audit concepts with coding standards, coverage and medical necessity criteria, documentation requirements, and payer policies.
  • Create audit concepts through research, data and claims analysis, rule documents, and code lists.
  • Review and update audit concepts in response to scheduled reviews, client and regulatory changes, HCPCS updates, DMEPOS fee schedules, and Home Health PPS final rules.
  • Track and interpret NCDs, DME MAC LCDs and Policy Articles, Medicare manuals, and CMS transmittals.
  • Interpret and apply commercial and Medicaid payer policies across states and managed care contracts.
  • Conduct quality reviews and check audit logic against post-acute billing rules and coding guidelines.
  • Find performance discrepancies and coordinate resolutions with clinical, coding, and operations teams.
  • Oversee multiple audit concept workflows at once and deliver accurate work on schedule.
  • Resolve escalated questions about DMEPOS, home health, and home infusion documentation and coverage.
  • Prepare training materials, job aids, reference tools, and documentation checklists.
  • Address client questions and assist with presentations, provider disputes, and escalations.
  • Track concept performance, analyze statistics and claims trends, and recommend ways to improve audit yield and accuracy.
  • Refine audit workflows, documentation, concept tracking, quality reviews, and cross-team coordination.
  • Take on other responsibilities and special projects as assigned.

आवश्यकताएँ

  • Bachelor’s degree in nursing, health administration, business, or a related field, or equivalent experience.
  • At least five years of progressive experience in durable medical equipment, home health, or home infusion therapy, including direct work in payment integrity, claims auditing, or provider-side billing and compliance.
  • Alternatively, at least three years of experience in post-acute claims auditing and recovery auditing.
  • An active Registered Nurse or nationally recognized certified coder credential, such as RHIA, RHIT, AHIMA, AAPC, or equivalent, is required.
  • Home health coding credentials (HCS-D, BCHH-C), OASIS certification (COS-C), or infusion nursing certification (CRNI) preferred.
  • Broad knowledge of ICD-10-CM, HCPCS Level II, CPT, HIPPS, DME fee schedules, the Competitive Bidding Program, Home Health PPS under PDGM, and the Medicare home infusion therapy benefit.
  • In-depth knowledge of DME MAC jurisdictions, LCDs, Policy Articles, supplier documentation, Standard Written Orders, face-to-face encounters, proof of delivery, continued need, and the DME Required Prior Authorization List.
  • In-depth knowledge of Medicare home health payment conditions, including homebound status, face-to-face encounters, certification and recertification, plans of care, OASIS assessments, and Notices of Admission.
  • Broad understanding of provider billing guidance, payer reimbursement policies, medical necessity criteria, and claim adjudication standards for post-acute services.
  • Expertise in clinical documentation requirements and developing audit concepts for post-acute claims.
  • Strong data utilization and statistical analysis experience, including setting scoring and selection methods for audit concepts.
  • Progressive healthcare data analysis experience and experience gathering and documenting requirements for projects of varied scope and complexity.
  • Experience creating clinical content, policy documentation, and training resources.
  • Ability to communicate effectively with people at all organizational levels, diverse teams, and external clients.
  • Excellent written and verbal communication skills and close attention to detail.
  • Strong critical thinking and analytical abilities.
  • Ability to manage several concurrent workflows independently in a remote setting and meet deadlines.
  • Proficiency with Windows and Microsoft applications, including Excel, Word, Outlook, PowerPoint, SharePoint, and Teams.
  • Advanced Microsoft Office skills, especially Excel and PowerPoint.
  • Familiarity with encoder and grouper applications, including the Home Health PDGM Grouper.
  • Experience using varied software platforms and working with development teams.
  • Demonstrated success working remotely.

लाभ

  • Remote work environment
  • At-will employment
  • Equal employment opportunity
  • Reasonable accommodation during the application or recruitment process

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