Content Innovation, Claims Editing

Machinify

. Monitor and interpret authoritative sources including CPT and HCPCS updates, ICD-10-CM guidelines, NCCI PTP and MUE tables, CMS manuals, NCDs and LCDs, specialty society guidance, and payer reimbursement policies .

Posted 10/15/2026full-timeRemote • United StatesSeniorLead💰 $135,000 - $165,000 per yearWebsite

Tech Stack

Tools & technologies

PythonSQL

About the role

Key responsibilities & impact

Monitor and interpret authoritative sources including CPT and HCPCS updates, ICD-10-CM guidelines, NCCI PTP and MUE tables, CMS manuals, NCDs and LCDs, specialty society guidance, and payer reimbursement policies
Translate coding rules, clinical guidelines, and reimbursement policy into precise, testable editing logic
Document the source, rationale, and scope of every edit
Separate portable market-wide content from client-specific policy
Maintain content through code updates, policy changes, and performance reviews; recommend refinements or retirement
Use claims data to test editing concepts, size opportunities, and estimate hit rate, false-positive rate, and savings
Review edit output and production results to identify gaps, over-reach, and missed opportunities
Track accuracy, hit rate, false positives, appeals, overturns, provider abrasion, and realized savings
Partner with Product, Engineering, and Data Science on requirements, logic specifications, and test cases
Help data scientists understand clinical and coding context
Evaluate AI tools, including large language models, for research, discovery, authoring, and quality review
Apply expert judgment to AI-generated content and define review standards
Explain content rationale, sources, and expected impact to clients and internal audiences
Support client policy review, edit approval, and appeals
Bring client feedback and operational findings into the content roadmap
Learn Machinify’s content portfolio, source library, technology, and development process
Own a content domain end to end and move data-validated concepts into production

Requirements

What you’ll need

7+ years of experience in claims editing, clinical coding, Payment Integrity, or payer policy, with hands-on experience authoring or validating edits
Active coding credential, such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license such as RN 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 to test hypotheses and measure results
Experience working with Product, Engineering, Data Science, or other multidisciplinary teams
Clear written communication and ability to explain complex coding and clinical logic to nonclinical audiences
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
Experience at a claims editing, Payment Integrity, or healthcare technology company preferred
Experience across commercial, Medicare Advantage, and Medicaid lines of business preferred
Clinical background with direct patient care experience preferred
Experience writing product requirements or logic specifications preferred
Experience with Python, SQL, or BI tools for claims analysis preferred
Experience presenting content rationale or savings analyses to health plan clients preferred

Benefits

Comp & perks

PTO, Paid Holidays, and Volunteer Days
Eligibility for health, vision and dental coverage
401(k) plan participation with company match
Flexible spending accounts
Tuition Reimbursement
Company-paid life insurance
Company-paid short-term disability
Company-paid parental leave
Remote and hybrid work options