IBR Policy and Content Development Analyst

Machinify

5d • $85,000 - $110,000 • Remote

About The Position

Machinify is a healthcare intelligence company that provides an AI-powered platform and expertise to health plan clients. The IBR Policy and Content Development Analyst develops, enhances, validates, and maintains clinical and coding solutions, serving as a subject matter expert on payment integrity policies. The role applies expertise in healthcare payment policies, facility billing, coding, and regulatory requirements, and works with operations, clinical, client services, IT, and audit teams to ensure concepts align with coding standards, medical necessity criteria, and client-specific payer policies.

The analyst reviews and updates audit concepts in response to scheduled cycles and policy, regulatory, or client changes; researches and analyzes the effects of those changes; and documents updates to rules and code lists. The role interprets payer policies and state-specific Medicare and Medicaid provider manuals, identifies policy gaps and opportunities for new concepts, and ensures concepts are appropriately developed for Medicaid, Medicare, and Commercial programs. It also supports testing, performance benchmarking, implementation validation, consistent application across platforms, workflow improvements, and the use of AI and automation to streamline policy research and development.

This is an exempt position. The role may be performed from anywhere in the United States. The stated base salary range is $85,000–$110,000 USD; compensation depends on factors including skill set, experience, and geographic location.

Requirements

• At least 3 years of experience performing payment integrity or auditing facility claims.
• Experience translating complex medical regulations and payer guidelines into clear, legally compliant clinical content and structured policy documentation.
• Deep understanding of Medicare and Commercial coding rules, regulations, and prospective payment systems.
• Broad knowledge of medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
• Knowledge of national coding standards, particularly payment rules.
• Strong organizational and written communication skills.
• In-depth knowledge of facility reimbursement methodologies and commercial and government payment policies to support contract compliance and audit integrity.
• Proficiency with Windows office systems and Microsoft Excel, Word, Outlook, PowerPoint, SharePoint, and Teams.
• Experience or proficiency using AI tools and automation platforms to optimize clinical research.
• Ability to communicate effectively across organizational levels and with diverse teams and clients.
• Ability to prioritize and multitask.
• At least one of the following coding certificates: RHIA, RHIT, CCS, CPC, or CPMA; alternatively, an active RN or LPN license.

Responsibilities

• Review and update existing audit concepts on regular cycles or in response to client or regulatory changes, including research, data and claim analysis, and updates to rule documents and code lists.
• Analyze regulatory, coding, or payer policy changes, determine their impact on existing concepts, and document findings.
• Interpret and apply client-specific payer policy in audit concept reviews and updates.
• Research and embed state-specific Medicare and Medicaid provider manuals and regional regulatory mandates into audit concept configurations.
• Evaluate payer policies to identify gaps and propose new audit concepts to clients.
• Ensure concepts are appropriately formulated across Medicaid, Medicare, and Commercial offering types and program lines.
• Align concepts with industry standards, including CMS, MUEs, and CPT/HCPCS coding guidelines.
• Develop, validate, and maintain audit concepts addressing coding unbundling in accordance with NCCI edits.
• Identify discrepancies in concept performance and coordinate resolution with clinical, coding, and operations teams.
• Benchmark concept outcomes against industry standards, historical data, and client baselines to identify gaps and optimization opportunities.
• Participate in testing new concepts to verify automated logic performs accurately in the system environment before implementation.
• Confirm audit concepts are validated against current coding guidelines, payment methodologies, and payer policy before deployment.
• Ensure audit teams apply policies consistently and correctly across platforms and client programs.
• Collaborate with cross-functional teams on clinical and coding solutions, audit strategies, payment integrity initiatives, and policies.
• Identify opportunities to improve audit concept workflows and documentation processes.
• Support improvements to concept tracking and cross-functional coordination.
• Use AI tools and automation to optimize policy development, streamline research, and scale payment integrity solution performance.
• Perform additional responsibilities and ad hoc projects as assigned to meet business needs.

Benefits

• Medical, dental, and vision offerings
• FSA/HSA
• Tuition reimbursement
• 401(k) with company match
• Additional health and wellness benefits and perks
• Flexible and trusting work environment

What This Job Offers

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