Content Innovation, Claims Editing (Multiple Levels)

Machinify

1d • $135,000 - $165,000

About The Position

Machinify is seeking a claims editing content expert to build the next generation of editing content and help make healthcare payments more accurate and affordable. The role sources, designs, validates, and maintains clinical and coding content for editing products, identifying opportunities in policy and claims data, translating them into defensible edits, and measuring their value for health plan clients.

This build-and-scale role sits at the intersection of clinical editing, coding, reimbursement policy, data science, and product development. The successful candidate will bring deep clinical editing and coding expertise, analytical judgment, and an interest in using AI to develop content more efficiently while maintaining quality and clinical accuracy. The position requires thinking in terms of evidence, measurable outcomes, and client value, but does not require being a data scientist.

The role collaborates with Product, Engineering, and Data Science to specify and test content, validate results with claims data, evaluate AI tools, and explain content rationale and impact to clients and internal teams. Success includes learning the content portfolio and development process, delivering validated content updates or concepts, owning a content domain, moving data-validated concepts into production, contributing to an AI-assisted workflow improvement, and demonstrating measurable results in accuracy, speed, or client value.

Requirements

• At least 7 years of experience in claims editing, clinical coding, Payment Integrity, or payer policy, including hands-on experience authoring or validating edits.
• An active coding credential such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license such as RN paired with deep coding experience.
• Deep, current knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI, MUEs, coding guidelines, and documentation requirements.
• Working knowledge of reimbursement methodologies, including fee schedules, DRGs, APCs, and professional and facility billing.
• Experience sourcing and interpreting primary content, including CMS manuals, NCDs and LCDs, AMA guidance, and payer policies.
• Strong analytical skills and comfort working with claims data using SQL, Excel, or similar tools to test hypotheses and measure results.
• Experience working with Product, Engineering, Data Science, or other multidisciplinary teams.
• Clear written communication and ability to explain complex coding and clinical logic to nonclinical audiences.
• Curiosity about AI tools and willingness to use them in daily content work.
• Sound judgment and comfort working in a fast-moving build-and-scale environment.

Nice To Haves

• Experience at a claims editing, Payment Integrity, or healthcare technology company.
• Experience across commercial, Medicare Advantage, and Medicaid lines of business.
• Clinical background (RN, LPN, or other licensed clinician) with direct patient care experience.
• Experience writing product requirements or logic specifications for engineering teams.
• Experience with Python, SQL, or BI tools for claims analysis.
• Experience presenting content rationale or savings analyses to health plan clients.

Responsibilities

• Monitor and interpret authoritative coding, clinical, and reimbursement sources, including CPT and HCPCS updates, ICD-10-CM guidelines, NCCI PTP and MUE tables, CMS manuals, NCDs and LCDs, specialty society guidance, and payer policies.
• Translate coding rules, clinical guidelines, and reimbursement policies into precise, testable editing logic.
• Document the source, rationale, and scope of edits so they are traceable, defensible on appeal, and maintainable.
• Distinguish portable, market-wide content from client-specific policy and clearly flag the difference in content and sizing work.
• Maintain existing content through code updates, policy changes, and performance reviews; recommend refinements or retirement of edits.
• Use claims data to test editing concepts, size opportunities, and estimate hit rates, false-positive rates, and savings.
• Review edit output and production results to assess whether edits work as intended and identify gaps, overreach, or missed opportunities.
• Track measures including accuracy, hit rate, false positives, appeals, overturns, provider abrasion, and realized savings.
• Prioritize opportunities based on potential value, confidence, and expected client return.
• Partner with Product, Engineering, and Data Science to turn content concepts into requirements, logic specifications, and test cases.
• Provide data scientists with clinical and coding context so models and analyses reflect how care is delivered and billed.
• Evaluate AI tools, including large language models, for policy research, concept discovery, content authoring, and quality review.
• Review AI-generated content using expert judgment and help establish standards to ensure accuracy.
• Explain the rationale, sources, and expected impact of editing content to client and internal audiences.
• Support client policy review, edit approval, and appeals with clear, well-sourced documentation.
• Incorporate client feedback and operational findings into the content roadmap.

Benefits

• PTO, paid holidays, and volunteer days.
• Eligibility for health, vision, and dental coverage.
• 401(k) plan participation with company match.
• Flexible spending accounts.
• Tuition reimbursement.
• Eligibility for company-paid life insurance and short-term disability benefits.
• Parental leave.
• Remote and hybrid work options.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed