Machinify is a healthcare AI platform and services company focused on improving payment integrity for health plans. Its AI operating system brings together claims, medical records, contracts, and policies, combining foundation models with task-specific agents to support coding, payment accuracy, recoveries, and cost avoidance. Machinify offers insourced, hybrid, and fully managed deployments, serving 85+ customers and covering 270 million member lives. The company reports more than $6 billion in annual cost avoidance and recoveries.
Senior Healthcare Data Analyst at Machinify — Remote US
Translate medical claims into canonical data models for Machinify’s AI-driven healthcare intelligence platform. Improve payment integrity, data quality, and analytics through claims expertise and AI-assisted workflows.
Description
- Build transformations that convert raw professional and institutional claims into Machinify’s canonical data models
- Apply healthcare coding standards across claims-transformation workflows
- Investigate, diagnose, and correct data-quality and completeness problems
- Use SQL and Spark SQL to verify pipeline results from ingestion through delivery
- Build working knowledge of Machinify’s platform, including data ingestion and claims adjudication
- Analyze overpayment signals, coordination-of-benefits discrepancies, and opportunities for billing edits
- Interpret payer policies, CMS requirements, and provider reimbursement methods
- Advance AI adoption by developing, testing, and refining LLM prompts
- Find manual workflows that can be automated and help develop AI-supported pipelines
- Help onboard new client data feeds while documenting transformation logic and data lineage
- Work with data engineers, data scientists, clinical professionals, and product managers to deliver scalable data solutions
- Collaborate with data scientists on advanced analytics and machine-learning initiatives
- Act as a subject-matter resource for claims coding, adjudication rules, and payer policy
- Coach analysts and engineers while advising stakeholders on risks, trends, and business implications
Requirements
- Bachelor’s degree in business, computer science, health informatics, or a related discipline
- At least five years of direct experience working with healthcare claims data, including 837 EDI, encounter data, or medical billing
- Advanced knowledge of professional and institutional claims, ICD-10-CM/PCS, CPT, HCPCS, UB-04, and CMS-1500
- Practical payment-integrity experience covering overpayment detection, coordination of benefits, billing edits, or claims-editing logic
- Working knowledge of CMS regulations and commercial payer guidelines governing claims adjudication and payment policy
- Advanced SQL skills, including the ability to develop complex analytical queries over large datasets
- Strong grasp of data modeling principles and analytics best practices
- Ability to explain healthcare processes and payment logic to health-plan clients, clinicians, and nontechnical stakeholders
- Proven ability to own and coordinate multiple initiatives at the same time
- Preferred: Knowledge of provider reimbursement methods such as MS-DRG/APR-DRG pricing, fee schedules, per diem, and capitation
- Preferred: Experience with Spark SQL or a similar distributed query engine
- Preferred: Experience contributing to ETL/ELT pipelines or partnering with data-engineering teams
- Preferred: Familiarity with value-based care or risk adjustment, including HCC coding and RADV
Benefits
- Work remotely from anywhere in the United States within a digital-first organization
- Medical, dental, and vision coverage for employees and their families
- Flexible workplace built on trust
- Unlimited flexible time off
- Equity or private-equity participation
- 401(k) plan with employer matching
- Flexible time off plus additional benefits and perks