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Machinify
Machinify
1001 – 5000 Zaposleni
Sponzor vizuma H1BLogistikaSvetovanjeZdravstveno varstvo
Machinify je platforma in ponudnik storitev na področju umetne inteligence v zdravstvu, osredotočen na izboljšanje celovitosti plačil za zdravstvene načrte. Njegov operacijski sistem z umetno inteligenco združuje zahtevke, zdravstveno dokumentacijo, pogodbe in pravilnike ter povezuje temeljne modele z agenti za posamezne naloge za podporo kodiranju, natančnosti plačil, izterjavi sredstev in preprečevanju stroškov. Machinify ponuja interne, hibridne in popolnoma upravljane uvedbe, oskrbuje več kot 85 strank ter pokriva 270 milijonov življenj članov. Podjetje navaja več kot 6 milijard dolarjev letno preprečenih stroškov in povrnjenih sredstev.
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Delovna mesta v podjetju

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.

USZdružene države AmerikeNa daljavoPolni delovni časSrednja ravenSeniorZahtevani Jezik: angleščinaAnalitik

Opis

  • 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.

Zahteve

  • 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.

Ugodnosti

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

Sorodna delovna mesta

Modivcare

Remote Compensation Analyst II at Modivcare

Modivcare
Sponzor vizuma H1BPrevozZdravstveno varstvoZdravstveno zavarovanje
USZdružene države Amerike
90.000 $ – 105.000 $ / leto
Na daljavoPolni delovni časSrednja ravenSeniorZahtevani Jezik: angleščinaAnalitik

Administer compensation programs, surveys, audits, and incentive planning for Modivcare’s healthcare transportation business. Maintain accurate compensation data and reporting across HR, Payroll, Finance, and HRIS systems.

Odpri