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।
Senior Specialty Pharmacy Claims Editing Content Lead
Develop specialty pharmacy and high-cost drug claims content for Machinify’s healthcare intelligence platform. Validate edits with claims data and work closely with Product and Data Science.
संयुक्त राज्य$1,35,000 – $1,65,000 / वर्ष
रिमोटपूर्णकालिकवरिष्ठलीडआवश्यक भाषा: अंग्रेज़ीकंटेंट मार्केटिंग मैनेजरविवरण
- Track and interpret coding, clinical, regulatory, pricing, and payer policy sources.
- Turn coding rules, clinical guidance, and reimbursement policies into precise, testable edit logic.
- Record each edit’s sources, reasoning, and scope to support traceability and appeals.
- Update content as codes and policies change, and review its performance.
- Create and maintain specialty drug edits covering billing units, NDC-to-HCPCS mappings, dosing, unit limits, dose rounding, and JW/JZ modifiers.
- Address oncology, immunology, rare diseases, biosimilars, and other high-cost treatment areas.
- Analyze claims data to test ideas, estimate opportunities, and track hit rates, false positives, and savings.
- Examine production results to find content gaps, overly broad edits, and missed opportunities.
- Work with Product, Engineering, and Data Science to define requirements, edit logic, test cases, and clinical context.
- Assess AI tools and use subject-matter expertise to review AI-generated content.
- Help clients review policies and approve edits, handle appeals, and improve the content roadmap.
- Lead a content area and advance concepts validated by data into production.
आवश्यकताएँ
- Bring at least seven years of experience in claims editing, clinical coding, Payment Integrity, or payer policy, including hands-on edit authoring or validation.
- Hold an active coding credential such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license such as RN combined with deep coding experience.
- Have current, in-depth knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI, MUEs, coding guidelines, and documentation requirements.
- Understand reimbursement methods including fee schedules, DRGs, APCs, and professional and facility billing.
- Have experience finding and interpreting CMS manuals, NCDs and LCDs, AMA guidance, and payer policies.
- Bring strong analytical skills and experience working with claims data in SQL, Excel, or similar tools.
- Have worked with Product, Engineering, Data Science, or other cross-functional teams.
- Communicate clearly in writing and explain complex coding and clinical logic to nonclinical audiences.
- Be curious about AI tools and willing to use them in day-to-day content work.
- Have at least three years of hands-on experience with medical benefit drug billing, coding, or policy, including HCPCS J-codes, NDCs, billing units, drug modifiers, and ASP-based reimbursement.
- Use sound judgment and be comfortable in a fast-paced, growing environment.
लाभ
- Paid time off, holidays, and volunteer days
- Eligibility for health, vision, and dental coverage
- 401(k) participation with company matching
- Flexible spending accounts
- Tuition reimbursement
- Company-paid life insurance
- Company-paid short-term disability coverage
- Company-paid parental leave
- Remote and hybrid work options