Senior Healthcare Data Analyst

Machinify

13d•$140,000 - $170,000•Remote

About The Position

Machinify is rebuilding how health plans audit and pay claims at scale using AI. The Senior Healthcare Data Analyst works at the intersection of healthcare domain expertise and data engineering, translating raw claims feeds into trusted canonical models, developing payment integrity insights, and serving as an internal expert on how claims move through adjudication. The role applies deep knowledge of healthcare data alongside modern AI tooling to accelerate analysis and build better solutions.

Requirements

Bachelor’s degree in Business, Computer Science, Health Informatics, or a related field.
At least 5 years of direct experience working with healthcare claims data, including 837 EDI, encounter data, or medical billing; experience at a health plan, payment integrity vendor, or healthcare analytics firm is preferred.
Deep knowledge of professional and institutional claim types, ICD-10-CM/PCS, CPT, HCPCS, and UB-04 and CMS-1500 formats.
Hands-on payment integrity experience, such as overpayment detection, COB, billing edits, or claim editing logic.
Familiarity with CMS regulations and commercial payer guidelines as they apply to claims adjudication and payment policy.
Advanced SQL proficiency and comfort writing complex analytical queries against large datasets.
Solid understanding of data modeling concepts and analytics best practices.
Strong communication skills, including the ability to discuss healthcare processes and payment logic with health plan clients, clinicians, and non-technical stakeholders.
Self-starter with strong ownership and accountability, able to manage multiple concurrent initiatives.

Nice To Haves

Working knowledge of provider reimbursement methodologies, including MS-DRG/APR-DRG pricing, fee schedules, per diem, and capitation.
Proficiency with Spark SQL or a comparable distributed query engine for large-scale data environments.
Exposure to ETL/ELT pipeline development or close collaboration with data engineers on pipeline design.
Exposure to value-based care arrangements or risk adjustment, including HCC coding and RADV.

Responsibilities

Design and implement transformations that convert raw medical and institutional claims, including 837 EDI, UB-04, and CMS-1500 data, into Machinify’s canonical models using healthcare coding standards such as ICD-10-CM/PCS, CPT, and HCPCS.
Audit data for accuracy and completeness, troubleshoot and resolve issues, and use SQL and Spark SQL to validate pipeline output end-to-end.
Develop deep working knowledge of Machinify’s platform, from data ingestion through claims adjudication, to ensure analytical solutions are accurate, traceable, and aligned with business needs.
Identify overpayment patterns, coordination of benefits (COB) issues, and billing edit opportunities using knowledge of payer policy, CMS regulations, and provider reimbursement methodologies.
Drive AI adoption by using and iterating on LLM prompts to accelerate analysis, identifying manual processes for automation, and contributing to AI-assisted pipeline development.
Support onboarding of new client data feeds, ensuring smooth integration and documenting transformation logic and data lineage.
Partner with data engineers, data scientists, clinical staff, and product managers to translate healthcare requirements into scalable data solutions; collaborate with data scientists on advanced analytics and machine-learning use cases.
Serve as a subject matter expert on claims coding, adjudication rules, and payer policy; mentor analysts and engineers and advise stakeholders on risk, trends, and business impact.