Machinify focuses on providing machine learning solutions to businesses and was created to help companies integrate artificial intelligence into everyday practi
Senior Content Analyst - Claims Editing
Location
United States
Posted
8 days ago
Salary
0
Seniority
Senior
No structured requirement data.
Job Description
Senior Content Analyst - Claims Editing
Machinify
Title: Senior Content Analyst (Claims editing) Location: US Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs. We’re seeking a skilled Senior Content Analyst to join our Claims Editing team! As a Sr. Content Analyst on the Payment Integrity – Policy & Content Management team, you will interpret healthcare reimbursement policies and translate them into precise, automated claims editing logic that drives payment accuracy. This is a deep subject-matter-expert role focused on applying regulatory guidance, coding standards, and payer rules to create deterministic, testable edits that identify incorrect coding, billing, and reimbursement. You’ll own edit concepts end-to-end, from interpretation through validation and ongoing refinement, with opportunities to contribute to the evolution of content approaches over time. This role offers high autonomy and ownership for someone who understands how claims should be paid and thrives on turning complex rules into clear, enforceable logic. What You’ll Do: Policy Interpretation & Edit Development - Interpret and apply CMS, Medicare, Medicaid, AMA/CPT, NCCI, and other payer policies to define accurate claims editing logic. - Translate regulatory and coding guidance into clear, deterministic pre-pay edits, with documented rationale and references. - Build and maintain a proprietary library of claims edits aligned to reimbursement rules and industry standards. - Identify reimbursement risk areas and policy interpretation gaps and encode them into actionable edit concepts. Claims Validation & Analysis - Own the development of high-quality edit specifications, including logic definitions, assumptions, edge cases, and validation criteria. - Analyze claims and edit performance data to confirm accuracy, reduce false positives, and prioritize enhancements by impact. - Conduct targeted manual claim reviews to validate coding accuracy, reimbursement correctness, and policy alignment. Cross-Functional Enablement - Serve as a SME across Medicare, Medicaid, and commercial claims. - Partner with product, engineering, and implementation teams to ensure edits are implemented and validated correctly. - Clearly document edit logic, policy interpretation, and outcomes to support internal teams and payer stakeholders. Governance & Ongoing Maintenance - Proactively monitor regulatory updates, coding changes, and industry guidance to keep edits current and compliant. - Ensure all edits are auditable, defensible, and aligned with external policy sources. - Consistently meet productivity and quality expectations in a remote, outcomes-driven environment. What You Bring: - 4+ years of experience in authoring claims editing content with either vendors or payers - Deep expertise in: - CMS policies (LCDs, NCDs, fee schedules) - NCCI (PTP and MUE) edits, OIG guidance, correct coding methodologies - CPT/HCPCS, ICD-10-CM/PCS, modifiers, place of service, and revenue codes - Strong understanding of claims processing workflows (CMS-1500, UB-04). Extra points if you bring: - SQL skills for claims analysis or edit opportunity identification. - Clinical background (RN, BSN, PharmD, MD, or equivalent). What We Offer: - 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 The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc. We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range. Equal Employment Opportunity at Machinify We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process
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Portfolio and Grant Analyst
Yale UniversityYale University is a prestigious, private, Ivy League research institution with roots dating back to the 17th century. Officially founded as Yale College in 171
Title: Portfolio & Grant Analyst, YSPH Location: Lab of Epidem, PUBHL Remote Full time Job requisition id 132423WD Job Description: Working at Yale means contributing to a better tomorrow. Whether you are a current resident of our New Haven-based community- eligible for opportunities through the New Haven Hiring Initiative or a newcomer, interested in exploring all that Yale has to offer, your talents and contributions are welcome. Discover your opportunities at Yale! Overview Reporting to the Post Award Grant Manager in the Yale School of Public Health (YSPH), this position will be responsible for the financial management and oversight of a portfolio of accounts, including financial reporting and analysis, budgeting, planning and compliance. This portfolio may include global/international awards; the individual will be responsible for being up to date with international business practices and will develop and manage relationships with foreign sub sites, OSP and PIs. Responsibilities include keeping abreast of laws, regulations, external and internal policies and procedures governing the administration of sponsored awards, contracts, gifts and endowments and serve as a resource to Program-related faculty and staff. Monitor trends and identify potential funding gaps and manage funds from external sponsors, University transfers and commitments. Creates and updates financial plans and financial reporting. Manages international subcontract process and collaborates with outside institutions to properly reconcile any advanced funds or funds sent directly to foreign sub sites. In collaboration with OSP and SPFA, work with PI’s and directors with sponsors for issues, including post award negotiations and conflict resolution. Partner with ORA, OSP and OISS offices to insure efficient business processes surrounding contracting, payment and reimbursement of Yale and non-Yale personnel and international entities, visitors and trainees. *While this position is largely remote, travel to campus may be required several times per year. Required skills and Abilities 1.Working knowledge of university organization; administrative and financial guidelines; Knowledge of accounting principles. 2.Demonstrated ability with financial tools and systems. Excellent knowledge of Microsoft Office, including Strong experience using Microsoft Excel. 3.Superior customer service skills and the ability to work collaboratively with all levels across the University, with external vendors, foreign and domestic collaborators. 4.Excellent communication skills, both written and verbal. Well-developed analytical and organizational skills. Ability to work as part of a team while being a self-starter able to work independently. 5.Ability to cultivate and maintain strong working partnerships and communicate with faculty and staff. Ability to take responsibility for assigned tasks. Preferred Education, Experience and Skills Bachelor’s degree in accounting, Business Management, or related field. Prior experience with Grants & Contract Administration, including International sponsored award affairs and administration. Workday Financials and/or the Yale Budgeting Tool (YBT), in addition to other University financial tools. Experience as an accountant/financial professional in a University setting. Principal Responsibilities 1. Financial Analysis and Reporting: Present financial information and recommendations thru data analysis and reporting in the development and maintenance of budgets. Identify funding issues and develop appropriate solutions. Review and approve reports for administrative actions including pre-award costs and no-cost extensions. Analyze data and develop complex analytical reports for principal investigators including trend analysis, forecast future financial scenarios, develop long range projections, and variance analyses. 2. Proposal Development: Develop proposals and budgets for grant and contract submissions; coordinate with partnering institutions. Ensure compliance with sponsor regulations and University policies and procedures. Advise principal investigators of new funding opportunities and requirements. 3. Portfolio Management: Plan, organize and prioritize actions across multiple awards and investigators' portfolios. Ensure appropriate charging of expenses and integration of data. Advise and counsel principal investigators on financial issues and recommend alternative spending strategies, manage renewals, extensions and closeouts of grants, including final financial reporting to the sponsor. Analyze and negotiate budgets, contracts, and terms and conditions of research proposals. 4. Compliance and Risk Management: Responsible for providing appropriate guidance on compliance matters during management of portfolio and collaborates with account holders to maintain such compliance. Review, interpret and effectively apply sponsor policies on a variety of topics including cost allowability, budget management and other award management activities to ensure compliance with sponsoring agency requirements and University policies and procedures. 5. Collaborative Finance Partner & Lead: Provides a high-level of service that maintains strong working relationships by interacting with faculty and internal and external contacts, such as the School of Medicine, Office of Research Administration and granting agencies by managing the internal pre award proposal process and the management of sponsored funding. 6. May perform other duties as assigned. Required Education and Experience Bachelor's degree required. Two years of related financial experience required. Demonstrated application of financial, accounting and economic concepts. Required License(s) or Certification(s) Required Licenses and Certifications Physical Requirements Physical Requirements Job Category Professional Bargaining Unit NON Compensation Grade Administration & Operations Compensation Grade Profile Supervisor; Senior Associate (P4) Salary Range $55,000.00 - $85,000.00 Time Type Full time Duration Type Staff Work Model Remote Background Check Requirements All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website. Health Requirements Certain positions have associated health requirements based on specific job responsibilities. These may include vaccinations, tests, or examinations, as required by law, regulation, or university policy. Posting Disclaimer Salary offers are determined by a candidate’s qualifications, experience, skills, and education in relation to the position requirements, along with the role’s grade profile and current internal and external market conditions. The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the position. Employees will be assigned specific job-related duties through their hiring department. The University is committed to basing judgments concerning the admission, education, and employment of individuals upon their qualifications and abilities and seeks to attract to its faculty, staff, and student body qualified persons from a broad range of backgrounds and perspectives. In accordance with this policy and as delineated by federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of that individual’s sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era or other covered veteran. Inquiries concerning Yale's Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA). Note Yale University is a tobacco-free campus.
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