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Senior Auditor - Pre/Post pay claim (Remote)
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Job Description
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
Machinify is seeking a Senior Auditor for pre and/or post pay data mining to conduct claims audits on behalf of Machinify’s customers. In addition, the Sr. Auditor will assist in concept ideation, product testing, quality enhancements, and related tasks to ensure customer satisfaction.
The ideal person for this role has a strong background in healthcare claims auditing, claims processing and coding, and a high level of understanding of payment guidelines for CMS and commercial payers.
What You'll Do:
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.
What You'll Bring:
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.
Preferred skills:
Data Mining experience - Post and Pre-pay
Payer auditing experience
Coding certification
What We Offer:
Work from anywhere in the US! Machinify is digital-first.
Flexible and trusting environment where you’ll feel empowered to do your best work
Unlimited PTO
Full Medical/Dental/Vision for employees & their families w/ 100% premium coverage options!
Competitive salary, equity, 401(k) sponsorship
Learning and Development reimbursement policy
The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc. The starting salary for this position is 100k+
Our Recruiting team will let you know if you qualify for a different role/range. Salary is one component of the total compensation package, which includes excellent healthcare, flexible time off, and other benefits and perks.
Equal Employment Opportunity at Machinify
Machinify is committed to hiring talented and qualified individuals with diverse backgrounds for all of its positions. Machinify believes that the gathering and celebration of unique backgrounds, qualities, and cultures enriches the workplace.
See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/
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