Data Mining Analyst
About The Position
Machinify is seeking an Analyst to help develop and refine reimbursement and payment integrity concepts. This is a hands-on healthcare domain role, not a technical or engineering position. The role requires in-depth knowledge of reimbursement logic, payment policies, and provider contracts, with the ability to turn that expertise into clear, structured concepts that inform analytics and automation efforts. The analyst will investigate where and why payment errors occur, design ways to detect and prevent them, and work with technical teams to operationalize findings. The role is suited to someone who enjoys analyzing claims data, identifying systemic payment issues, and shaping technology solutions that capture real-world reimbursement logic.
Requirements
- At least 2 years of experience in healthcare data mining or claims editing on the provider, payer, or vendor side.
- Deep understanding of provider contracts, including rate structures, carve-outs, and reimbursement methodologies.
- Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers.
- Ability to identify improper payment patterns, root causes, and opportunities for correction.
- Strong investigative and deductive reasoning skills, with the ability to connect policy, data, and contractual details.
- Comfort working closely with technical teams to guide implementation of business logic.
- Self-directed, detail-oriented, and adaptable in a fast-paced, growing environment.
Responsibilities
- Lead pre- and post-payment claim reviews to identify inaccurate payments using reimbursement and contract expertise.
- Analyze and interpret provider contracts to ensure payments align with negotiated terms, methodologies, and payer rules.
- Collaborate with engineering and data science teams to translate business and reimbursement logic into analytical and automation frameworks.
- Analyze claim-level data to identify root causes of overpayments or incorrect denials and recommend corrective approaches.
- Maintain expertise on CMS and commercial payer reimbursement guidelines.
- Support quality review, concept validation, and process improvement initiatives.
Benefits
- Medical, dental, and vision offerings.
- FSA/HSA.
- Tuition reimbursement.
- Competitive salary.
- 401(k) with company match.
- Additional health and wellness benefits and perks.
- Flexible and trusting work environment.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
