Senior Auditor - Prepay, Postpay Data Mining

Summary

Join Machinify, a leading provider of AI-powered healthcare software, as a Sr. Auditor. You will conduct pre and post-pay claims audits for our clients, utilizing various resources to ensure accuracy and compliance. This role also involves contributing to concept ideation, product testing, and process improvements. The ideal candidate possesses extensive experience in healthcare claims auditing, coding, and payment guidelines. You will be responsible for developing and refining reimbursement policies and identifying new payment error concepts. Machinify offers a remote work environment, competitive salary and equity, excellent healthcare benefits, and a generous learning and development reimbursement policy.

Requirements

• 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
• 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

Responsibilities

• 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

Preferred Qualifications

• Data Mining experience - Post and Pre-pay
• Payer auditing experience
• Coding certification

Benefits

• Work from anywhere in the US!
• A flexible and trusting environment where you'll feel empowered to do your best work
• Hardworking and supportive colleagues and a leadership team that understands the importance of recruiting and retaining top talent
• Incredible Medical/Dental/Vision benefits for employees & their families
• Competitive salary and equity, 401(k) sponsorship, life insurance
• Generous Learning and Development Reimbursement policy
• Flexible time off