# Senior Content Analyst (Claims editing)

**Company:** [Machinify](https://hotfix.jobs/companies/machinify)
**Location:** Remote
**Role:** Other
**Experience:** 4+ years
**Skills:** Cms Policies, Ncci Edits, Cpt, Hcpcs, Icd-10, SQL, Claims Editing, Medicare, Medicaid, Oig Guidance
**Posted:** 2026-03-26

> Senior Content Analyst interprets healthcare reimbursement policies (CMS, Medicare, Medicaid, NCCI) and translates them into automated claims editing logic. Owns edit development, validation, and maintenance in a remote role, requiring 4+ years of claims editing experience and deep coding expertise.

## Job Description

## 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).

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