Data Mining Sr. Analyst

Machinify

7d•$125,000 - $135,000•Remote

About The Position

Machinify is seeking a Senior Analyst to lead the development and refinement of new 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, translating that expertise into clear, structured concepts that inform analytics and automation efforts. The Senior Analyst will discover where and why payment errors occur, design methods to detect and prevent them, and partner with technical teams to operationalize findings. The position focuses on analyzing claims data, identifying systemic payment issues, and shaping how technology solutions capture real-world reimbursement logic. The role is digital-first and can be performed from anywhere in the US.

Requirements

At least 5 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.

Nice To Haves

Coding certification, such as CPC, CCS, or equivalent.
Working proficiency in SQL for data exploration and validation.
Prior experience in cross-functional R&D or innovation teams focused on healthcare payment integrity.

Responsibilities

Lead pre- and post-pay 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.
Research and document emerging reimbursement and contract patterns, coverage rules, and billing practices to inform concept development.
Translate complex reimbursement and contract scenarios into structured rules and business logic for implementation.
Analyze claim-level data to pinpoint 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.