Content Innovation, Claims Editing - NY Medicaid (Multiple Levels)

The role

You will source, design, validate, and maintain clinical and coding content for editing products. You will focus on New York State Medicaid policy and use claims data to test and measure editing logic.

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 reimbursement policy into editing logic
• Document source, rationale, and scope of every edit
• Maintain existing content through code updates and policy changes
• Monitor and interpret New York Medicaid sources
• Translate New York reimbursement rules into editing logic
• Use claims data to test editing concepts and estimate savings
• Partner with Product, Engineering, and Data Science teams
• Support client policy review, edit approval, and appeals

Required qualifications

• 7+ years of experience in claims editing, clinical coding, Payment Integrity, or payer policy
• 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
• At least 3 years of experience with New York State Medicaid policy, billing, or Payment Integrity
• Working knowledge of eMedNY, APGs, APR-DRGs, and NYS DOH and OMIG guidance
• Sound judgment and comfort working in a fast-moving build-and-scale environment

Nice to have

• Experience at a New York Medicaid managed care plan, the NYS Department of Health, OMIG, or a vendor serving New York Medicaid
• Experience with New York behavioral health, HARP, OASAS, OMH, or long-term care billing
• 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.