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Machinify logo
Machinify

The future of payment integrity.

Senior Analyst, Data Mining

AnalystAnalystFull TimeRemoteSeniorTeam 1,001-5,000H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

68 days ago

Salary

0

Seniority

Senior

5 yrs expEnglish

Job Description

Senior Analyst, Data Mining

Machinify

• 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 closely 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.

Job Requirements

  • 5+ years 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.
  • Proven ability to identify improper payment patterns, root causes, and opportunities for correction.
  • Strong investigative and deductive reasoning skills; able to connect policy, data, and contractual details.
  • Comfortable working in close collaboration with technical teams to guide implementation of business logic.
  • Self-directed, detail-oriented, and adaptable to a fast-paced, growing environment.

Benefits

  • Work from anywhere in the US! Machinify is digital-first.
  • Top Medical/Dental/Vision offerings
  • FSA/HSA
  • Solid PTO program
  • Tuition reimbursement
  • Competitive salary, 401(k) with company match
  • Additional health and wellness benefits and perks
  • Flexible and trusting environment where you’ll feel empowered to do your best work

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