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Tech Stack
Tools & technologiesETLSparkSQL
About the role
Key responsibilities & impact- Design and implement transformations converting raw medical and institutional claims into Machinify’s canonical models
- Apply healthcare coding standards throughout claims transformation
- Audit, troubleshoot, and resolve data-quality and completeness issues
- Write SQL and Spark SQL queries to validate pipeline output end-to-end
- Develop expertise in Machinify’s platform from data ingestion through claims adjudication
- Identify overpayment patterns, coordination-of-benefits issues, and billing-edit opportunities
- Apply payer policy, CMS regulations, and provider reimbursement methodologies
- Drive AI adoption by prompting and iterating with LLMs
- Identify manual processes suitable for automation and contribute to AI-assisted pipeline development
- Support onboarding of new client data feeds and document transformation logic and lineage
- Partner with data engineers, data scientists, clinical staff, and product managers on scalable data solutions
- Collaborate with data scientists on advanced analytics and machine-learning use cases
- Serve as subject-matter expert on claims coding, adjudication rules, and payer policy
- Mentor analysts and engineers and advise stakeholders on risk, trends, and business impact
Requirements
What you’ll need- Bachelor's degree in Business, Computer Science, Health Informatics, or a related field
- 5+ years working directly with healthcare claims data, including 837 EDI, encounter data, or medical billing
- Deep knowledge of professional and institutional claim types, ICD-10-CM/PCS, CPT, HCPCS, UB-04, and CMS-1500
- Hands-on payment integrity experience, including overpayment detection, COB, billing edits, or claim editing logic
- Familiarity with CMS regulations and commercial payer guidelines for claims adjudication and payment policy
- Advanced SQL proficiency and ability to write complex analytical queries against large datasets
- Solid understanding of data modeling concepts and analytics best practices
- Ability to discuss healthcare process and payment logic with health plan clients, clinicians, and non-technical stakeholders
- Ability to manage multiple concurrent initiatives with strong ownership and accountability
- Preferred: Working knowledge of provider reimbursement methodologies, including MS-DRG/APR-DRG pricing, fee schedules, per diem, and capitation
- Preferred: Proficiency with Spark SQL or a comparable distributed query engine
- Preferred: Exposure to ETL/ELT pipeline development or data-engineering collaboration
- Preferred: Exposure to value-based care arrangements or risk adjustment, including HCC coding and RADV
Benefits
Comp & perks- Work from anywhere in the US; digital-first workplace
- Full Medical/Dental/Vision for employees and their families
- Flexible and trusting environment
- Unlimited FTO
- Equity/private equity
- 401(k) including employer match
- Flexible time off and other benefits and perks