[Hiring] Content Innovation, Claims Editing @Machinify

Role Description

Machinify is redefining Payment Integrity through smarter technology, richer data, and intelligent automation. We are seeking a claims editing content expert to help build the next generation of editing content and make healthcare payments more accurate and affordable. This role will bring deep expertise in New York State Medicaid.

As Content Innovation, Claims Editing - NY Medicaid you will:

• Source, design, validate, and maintain the clinical and coding content that powers our editing products.
• Find opportunities in policy and in the data, turn them into edits that hold up, and measure whether they deliver value for our health plan clients.
• Focus on New York State Medicaid, being our go-to expert on state policy and how it shapes editing.
• Work at the intersection of clinical editing, coding, reimbursement policy, data science, and product development.

Qualifications

• 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 the ability to explain complex coding and clinical logic to nonclinical audiences.
• Curiosity about AI tools and willingness to use them in daily content work.
• At least 3 years of experience with New York State Medicaid policy, billing, or Payment Integrity, including working knowledge of eMedNY, APGs, APR-DRGs, and NYS DOH and OMIG guidance.
• Sound judgment and comfort working in a fast-moving build-and-scale environment.

Requirements

• Experience at a New York Medicaid managed care plan, the NYS Department of Health, OMIG, or a vendor serving New York Medicaid.
• Experience with New York behavioral health, HARP, OASAS, OMH, or long-term care billing.
• Experience at a claims editing, Payment Integrity, or healthcare technology company.
• Experience across commercial, Medicare Advantage, and Medicaid lines of business.
• Clinical background (RN, LPN, or other licensed clinician) with direct patient care experience.
• Experience writing product requirements or logic specifications for engineering teams.
• Experience with Python, SQL, or BI tools for claims analysis.
• Experience presenting content rationale or savings analyses to health plan clients.

Benefits

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

What Success Looks Like…

First 90 Days: You will learn Machinify’s content portfolio, source library, technology, and development process; build working relationships with Product and Data Science; assess current New York Medicaid coverage against state policy; and deliver a prioritized list of New York content gaps and opportunities.

Within 6 to 12 months: You will own a content domain end to end, move multiple data-validated concepts into production, maintain accurate and current source documentation, contribute to at least one AI-assisted improvement in how content is built, set up a repeatable process for tracking New York policy changes, and show measurable results in edit accuracy, speed, or client value.

Pay range

$135,000 - $165,000 USD. This exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.

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 are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know.