[Hiring] Audit Policy Analyst @Machinify

Role Description

As part of the Complex Payment Solutions (CPS) Team, the Audit Policy Analyst, Post-Acute Services serves as the subject matter expert for durable medical equipment (DME), home health, and home infusion therapy claims across government and commercial lines of business. This role leads the development, maintenance, testing, and optimization of post-acute payment integrity audit concepts and partners with operations, clinical, client services, and technology teams to ensure each concept is built, validated, and maintained in alignment with coding standards, coverage and medical necessity criteria, documentation requirements, and client-specific payer policy.

The ideal candidate brings authoritative, hands-on knowledge of how post-acute services are ordered, documented, billed, and paid, including DME MAC policy, the Home Health Patient-Driven Groupings Model (PDGM), and the Medicare home infusion therapy benefit. This role requires strong analytical and communication skills, a track record of leading audit concept development, the ability to manage complex workflows independently, and the ability to mentor a team of subject matter experts.

Qualifications

• Bachelor's degree in nursing, health administration, business, or a related field, or equivalent experience.
• Minimum 5+ years of progressive experience in DME, home health, and/or home infusion therapy, including direct experience in payment integrity, claims auditing, or provider-side billing and compliance.
• Equivalent experience of 3+ years in post-acute claims auditing and recovery auditing.
• Registered Nurse or Certified Coder holding a nationally recognized credential (RHIA, RHIT, AHIMA, AAPC, or equivalent) required.
• Home health coding (HCS-D, BCHH-C), OASIS (COS-C), or infusion nursing (CRNI) credential preferred.

Requirements

• Demonstrated depth and breadth of knowledge across post-acute coding systems and payment methodologies, including ICD-10-CM, HCPCS Level II, CPT, and HIPPS.
• Deep understanding of DME MAC jurisdictions, LCDs, Policy Articles, and supplier documentation requirements.
• Broad knowledge of provider billing guidelines, payer reimbursement policies, medical necessity criteria, and claim adjudication standards for post-acute services.
• Strong experience in data utilization and statistical analysis, including driving scoring and selection for audit concepts.
• Exceptional written and verbal communication skills with strong attention to detail.
• Demonstrated ability to manage multiple concurrent workflows independently and in a remote environment, delivering results on time.

Benefits

• Equal Employment Opportunity at Machinify.
• We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status.
• We participate in E-Verify as required by applicable law.