Senior Auditor - Prepay, Postpay Data Mining

March 10

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Machinify, Inc.

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Machinify, Inc. is a company specializing in artificial intelligence solutions for the healthcare industry, particularly in optimizing payment processes and enhancing payment integrity. Their product suite, including Machinify Audit and Machinify Pay, is designed to automate and improve the accuracy of medical claims review, identifying billing and coding errors, and reducing administrative costs. Machinify's AI-driven platform covers millions of healthcare members and delivers significant financial benefits by efficiently processing medical claims and empowering health plans to tailor their policies. With a focus on transparency, control, and safety in AI, Machinify offers customized solutions that adapt to the specific needs of healthcare providers and contribute to the transformation of healthcare payments.

Machine Learning • Deep Learning • Large-scale Data Processing • Cluster Computing • Real-time predictions

51 - 200 employees

🤖 Artificial Intelligence

⚕️ Healthcare Insurance

💳 Fintech

💰 $10M Series A on 2018-10

📋 Description

• Conduct comprehensive reviews of pre and post pay claims using any and all available resources, including but not limited to, claims data and client adjudication systems, payment guidelines and compliance with regulatory requirements, contract, pricing systems, medical records, authorizations, etc. • Serve as a claims billing and payment expert, and resource for the data teams and other departments. • Develop and refine reimbursement policies and procedures in collaboration with the team. • Remain updated with the latest billing guidelines and regulations. • Achieve the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation. • Additional responsibilities as assigned or needed to support the business. • Identify new payment error concepts. Identifies potential claims outside of the concept where additional recoveries may be available. Suggests and develops high-quality, high-value concepts and or process improvement, tools, etc.

🎯 Requirements

• 5+ years of relative experience • Ability to review payment information against Medicare and payer billing guidelines to make determinations relating to the appropriateness of payments • Experience or certification in coding/billing is helpful • Ability to meet deadlines • Willingness and ability to do whatever is necessary to accomplish workload demands • Delivery of high-quality work is critical • Strong attention to detail; investigative and deductive reasoning skills are a must • Must be able to make decisions and conclusions when working with limited information using reference materials and strong problem-solving skills • Proficiency in Excel, Word, Google Sheets, Slack/messaging platform, etc. • Able to work in a fast paced environment and adapt to rapid change and growth.

🏖️ Benefits

• Work from anywhere in the US! Our team is distributed and most of us work from home • A flexible and trusting environment where you'll feel empowered to do your best work • Hardworking and supportive colleagues and a leadership team that understands the importance of recruiting and retaining top talent • Incredible Medical/Dental/Vision benefits for employees & their families. • Competitive salary and equity, 401(k) sponsorship, life insurance • Generous Learning and Development Reimbursement policy