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Machinify

IBR Policy and Content Development Analyst

Machinify

. Develop, enhance, and maintain clinical and coding payment integrity solutions.

Posted 10/16/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 - $110,000 per yearWebsite

Core Competencies

Role fit
Core Competencies

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Demonstrates expertise in payment integrity solutions, regulatory compliance, and clinical coding, with a strong focus on Medicare and Commercial coding rules. Proficient in utilizing AI tools and automation to enhance audit processes and ensure accurate policy application across diverse healthcare settings.

Highest-signal resume keywords
Payment Integrity Solutions DevelopmentMedicare And Commercial Coding RulesAI Tools And Automation ProficiencyClinical Content DocumentationCoding Certifications (RHIA, RHIT, CCS, CPC, CPMA)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills
Payment IntegrityAudit ConceptsData AnalysisCoding GuidelinesRegulatory ComplianceMedical Claims BillingReimbursement MethodologiesPolicy DocumentationConcept ValidationWorkflow Improvement
Soft Skills
Organizational SkillsWritten CommunicationEffective CommunicationPrioritizationMultitasking
Tools & Technologies
Microsoft ExcelMicrosoft WordMicrosoft OutlookMicrosoft PowerPointMicrosoft SharePointMicrosoft TeamsAI Tools
Certifications & Qualifications
RHIARHITCCSCPCCPMAActive RN LicenseActive LPN License
Industry Keywords
MedicareMedicaidPayer PoliciesCoding TerminologyPayment PoliciesAudit IntegrityClinical ResearchCompliance StandardsHealthcare RegulationsNational Coding Standards

About the role

Key responsibilities & impact
  • Develop, enhance, and maintain clinical and coding payment integrity solutions.
  • Review and update audit concepts on regular cycles or in response to client or regulatory changes, including research, data/claim analysis, rule-document updates, and code-list updates.
  • Research and analyze the impact of regulatory, coding, or payer-policy changes on existing concepts and document findings.
  • Interpret and apply client-specific payer policies in audit concept reviews and updates.
  • Embed state-specific Medicare/Medicaid provider manuals and regional regulatory mandates into audit concept configurations.
  • Evaluate payer policies to identify gaps and propose new audit concepts to clients.
  • Ensure audit concepts are correctly formulated across Medicaid, Medicare, and Commercial programs.
  • Align concepts with CMS, MUEs, CPT/HCPCS coding guidelines, and NCCI edits.
  • Identify discrepancies in concept performance and drive resolution with clinical, coding, and operations teams.
  • Benchmark concept outcomes against industry standards, historical data, and client baselines.
  • Test new concepts to verify automated logic before implementation.
  • Validate concepts against coding guidelines, payment methodologies, and payer policy before deployment.
  • Ensure consistent policy application across platforms and client programs.
  • Collaborate with operations, clinical, client services, and IT teams on coding solutions, audit strategies, and payment integrity initiatives.
  • Improve audit concept workflows, documentation, tracking, and cross-functional coordination.
  • Use AI tools and automation to optimize policy development, streamline research, and scale solution performance.
  • Perform additional responsibilities and ad hoc projects as assigned.

Requirements

What you’ll need
  • 3+ years’ experience performing payment integrity or auditing facility claims.
  • Experience translating complex medical regulations and payer guidelines into clear, legally compliant clinical content and structured policy documentation.
  • Deep understanding of Medicare and Commercial coding rules, regulations, and prospective payment systems.
  • Broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
  • Knowledge of national coding standards, particularly payment rules.
  • Strong organizational and written communication skills.
  • In-depth knowledge of diverse facility reimbursement methodologies and commercial/government payment policies to ensure accurate contract compliance and audit integrity.
  • Proficient in Windows office systems, including the full Microsoft Suits (Excel, Word, Outlook, PowerPoint, SharePoint, and Teams).
  • Demonstrated experience or proficiency in utilizing AI tools and automation platforms to optimize clinical research.
  • Proven ability to communicate effectively with all levels of the organization, with diverse teams, and with clients.
  • Ability to prioritize and multitask.
  • At least one of the following coding certificates: RHIA, RHIT, CCS, CPC, CPMA.
  • Or, Active RN/LPN License.

Benefits

Comp & perks
  • Work from anywhere in the US! Machinify is digital-first.
  • Top Medical/Dental/Vision offerings
  • FSA/HSA
  • Tuition reimbursement
  • Competitive salary
  • 401(k) with company match
  • Additional health and wellness benefits and perks
  • Flexible and trusting environment where you’ll feel empowered to do your best work