Content Innovation, Claims Editing (Multiple Levels)

The role

You will source, design, validate, and maintain clinical and coding content for editing products. You will use claims data to test concepts and partner with Product and Data Science teams to turn content into logic specifications.

What you will do

• Source and author editing content
• Monitor and interpret authoritative sources like CPT, HCPCS, and ICD-10-CM
• Translate coding rules and clinical guidelines into testable editing logic
• Document source, rationale, and scope of every edit
• Maintain existing content through code updates and policy changes
• Use claims data to test editing concepts and estimate savings
• Review edit output to confirm edits fire as intended
• Work with Product, Engineering, and Data Science to turn concepts into requirements
• Evaluate where AI tools can speed up research and authoring
• Explain rationale and expected impact to client and internal audiences

Required qualifications

• 7+ years of experience in claims editing, clinical coding, Payment Integrity, or payer policy
• Hands-on experience authoring or validating edits
• Active coding credential, such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license paired with deep coding experience
• Deep, current knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI, MUEs, coding guidelines, and documentation requirements
• Working knowledge of reimbursement methodologies, including fee schedules, DRGs, APCs, and professional and facility billing
• Experience sourcing and interpreting primary content, including CMS manuals, NCDs and LCDs, AMA guidance, and payer policies
• Strong analytical skills and comfort working with claims data, using SQL, Excel, or similar tools
• Experience working with Product, Engineering, Data Science, or other multidisciplinary teams
• Clear written communication
• Curiosity about AI tools and willingness to use them in daily content work
• Sound judgment and comfort working in a fast-moving build-and-scale environment

Nice to have

• Experience at a claims editing, Payment Integrity, or healthcare technology company
• Experience across commercial, Medicare Advantage, and Medicaid lines of business
• Clinical background (RN, LPN, or other licensed clinician) with direct patient care experience
• Experience writing product requirements or logic specifications for engineering teams
• Experience with Python, SQL, or BI tools for claims analysis
• Experience presenting content rationale or savings analyses to health plan clients

Benefits

• PTO
• Paid Holidays
• Volunteer Days
• Health, vision and dental coverage
• 401(k) plan participation with company match
• Flexible spending accounts
• Tuition Reimbursement
• Life insurance
• Short-term disability
• Parental leave

About the company

Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients through an AI-powered platform.