Retrieve and document medical records through various channels while ensuring data accuracy and HIPAA compliance. Collaborate with cross-functional teams to troubleshoot issues and maintain operational documentation.
Machinify
43 Remote Job Openings at Machinify
Lead a remote team of outpatient coding auditors to identify overpayment opportunities through pre-payment and post-payment reimbursement audits. Oversee operational excellence via capacity planning, productivity monitoring, and the application of OPPS and APC/APG guidelines.
Manage end-to-end event operations including industry conferences, webinars, and the annual customer summit. Coordinate logistics, budget tracking, and lead capture while reporting performance metrics to executive leadership.
Perform retrospective and prepayment medical claims audits for Skilled Nursing Facility (SNF) services. Document findings, generate audit letters, and collaborate with clients to improve medical policies and provider education.
Responsible for reviewing incoming claims, organizing data, and routing files to auditors while ensuring data accuracy. Collaborates with internal teams to manage import queues, reconcile balances, and monitor file-sharing processes.
Perform retrospective and prepayment medical claims audits for inpatient settings using established guidelines and policies. Document findings, generate audit letters, and collaborate with the team to identify potential abuse and improve workflows.
Lead the transformation of pharmacy payment integrity from manual workflows to AI-first automation, owning the roadmap for AI agents and voice AI. Design automated payment recovery workflows and redesign customer-facing analytics portals to demonstrate ROI.
Oversee daily recovery efforts and staff productivity to ensure goals and SLAs are met. Collaborate with leadership to develop training materials, operational procedures, and handle escalated provider communications.
Oversee the daily execution of quality assurance programs across operational departments including Customer Service and Repricing. Ensure consistent application of quality standards through audits, calibration sessions, and performance coaching.
Perform secondary reviews of outpatient coding validation audits to ensure accuracy, consistency, and compliance with regulatory standards. Monitor auditor performance, provide coaching, and develop quality assurance tools to improve operational excellence.
Lead and grow the AI/ML Engineering team to design, deliver, and operate a scalable core AI/ML platform. Partner with the Chief AI Officer to bridge the gap between data science proof-of-concepts and production-grade services.
Lead client interactions and operational processes to improve satisfaction and value within a healthcare payment integrity platform. Collaborate with technical teams to deliver actionable insights from claims data and manage client strategy and reporting.
Extract hidden patterns and insights from large healthcare datasets to drive business strategy and operational efficiency. Lead small data projects and create comprehensive reports and visualizations to communicate results to diverse audiences.
Design and build scalable, reliable full-stack web applications that apply ML techniques to large volumes of data. Balance the development of new customer-facing features with technical debt cleanup to ensure software sustainability.
Manage software development project delivery schedules and coordinate cross-functional efforts between Data Science, Engineering, and DevOps. Drive engineering processes and ensure product requirements align with end-to-end delivery commitments.
Own end-to-end data science workflows to build and productionize ML and LLM-powered solutions for healthcare payment intelligence. Lead high-impact initiatives and set technical direction through mentorship and design reviews to improve business outcomes.
Develop and refine product messaging, positioning, and value propositions to translate complex AI capabilities into clear narratives for healthcare payers. Support the creation of sales enablement tools, video content, and the coordination of product launches.
Oversee quality assurance for DRG Reviewers to ensure adherence to clinical and coding standards. Conduct training sessions for new and existing staff to enhance skill development and performance.
Facilitate work products between the company and clients by handling requirements gathering, analysis, and delivery validation for Complex Payment Solutions. Monitor client inventory, manage Jira tickets, and act as a liaison between IT and Operations teams to resolve production issues.
You will own the end-to-end product lifecycle for the Coordination of Benefits (COB) line, including strategy, roadmap, and execution. You will drive the vision for AI-native workflows to improve claims recovery and operational efficiency.
Conduct comprehensive outpatient payment validation reviews to ensure accurate coding, billing, and compliance with payer policies. Document audit findings and provide well-supported rationales for reimbursement impacts using industry-standard references.
The analyst will review facility insurance claims and itemized statements to ensure the accuracy of charges against medical documentation and compliance guidelines. They will also collaborate with internal teams to improve claim review efficiency and assist in content development and research.
The Software Architect will own the design and implementation of the intelligent document processing and agentic evaluation framework. This role involves hands-on technical leadership, defining system abstractions, and ensuring the platform scales to process healthcare documents at a high volume.
The Senior Director will lead end-to-end business development across federal and state government markets, focusing on Medicaid and federal health agencies. They will manage the full sales cycle, including RFP responses, strategic partnerships, and policy-driven market positioning.
You will drive the data product roadmap by partnering with engineering and architecture leadership to translate business needs into technical requirements. The role involves coordinating the consolidation of legacy systems into a unified AI-powered platform while enabling new product capabilities across the healthcare payment continuum.
Develop and advance machine learning models to optimize healthcare claim audits and improve financial outcomes. Create technical frameworks and data pipelines to enhance team efficiency and model precision.
Design and implement robust, production-grade data pipelines to process high-volume datasets and integrate raw customer data into internal models. Collaborate with cross-functional teams to ensure data accuracy, observability, and performance while supporting ML models and product experiences.
The role involves contributing to backend server-side development to ensure the application is extensible, scalable, and secure, while also designing and architecting complex frameworks for applying ML techniques to large data volumes. Responsibilities include recognizing and prioritizing customer deliverables versus technical debt to maintain a sustainable software suite.
The role involves developing new applications and contributing to UI and potentially middle-layer development, while owning projects aligned with the product development strategy. Responsibilities also include designing intuitive user experiences and collaborating with stakeholders like Product Managers and UX teams.
The role involves conducting thorough DRG payment validation reviews, including clinical and coding assessments of medical records to ensure accurate payment determinations based on contract-specific criteria. Key duties include meticulously documenting findings, providing clinical and policy support, and collaborating with stakeholders to maintain compliance with payment standards.
The role involves designing and building scalable, high-performance data software solutions primarily using Golang and Python, while also building and deploying Kubernetes-based systems for containerized applications in cloud-native environments. Engineers will collaborate cross-functionally to optimize backend infrastructure performance, reliability, and security, focusing on data transformation for machine learning workflows.
The DRG Manager will be responsible for the development and management of clinical solutions, including MS and APR-DRG validation, requiring expertise in healthcare payment methodologies and audit criteria. Key duties involve leading the DRG team, overseeing clinical claims review processes, monitoring regulatory updates, and ensuring optimal team performance.
This role is responsible for leading the build and deployment of classical Machine Learning and Generative AI systems to generate and validate concepts related to billing errors, audits, and fraud within large-scale healthcare payment data. The Staff Data Scientist will own the end-to-end delivery process, from problem framing and data strategy through model development, evaluation, deployment, and monitoring, focusing on reliability and customer outcomes.
The Data Scientist will translate complex medical policies and clinical criteria into executable SQL and Python code, focusing on building robust clinical feature pipelines from extracted signals in medical records. They will also own the measurement, evaluation, and continuous quality improvement of the AI system responsible for extracting structured clinical information.
The role involves solving complex problems in medical document understanding and question-answering by applying modern Natural Language Processing and vision methodologies. Responsibilities include making data-driven decisions on algorithms, working with limited labeled data, and continuously optimizing models for production scalability and performance.
The Staff Data Scientist will be responsible for advancing machine learning models used for identifying and auditing claims errors, requiring deep dives into clinical and coding data to improve audit precision. This role also involves enhancing data pipelines, modeling infrastructure, and team tools to scale capabilities and ensure model insights align with real business needs.
The Staff Software Engineer will lead the design and development of large-scale systems to integrate cutting-edge AI into production for Payment Integrity and Audit solutions. This includes leading document processing pipelines and designing agentic workflows to review and validate millions of healthcare claims annually.
This hands-on role involves deep involvement in architectural design, part-time coding, and code reviews while leading the development and production releases of robust solutions for healthcare subrogation product lines. The manager will lead a small team, develop production feature plans for on-time releases, and work to reduce team pain points and increase velocity.
Develop new applications and contribute to UI and middle-layer development. Collaborate with team and external stakeholders to design and implement solutions for an intuitive user experience.
The engineer will act as a Rust Coach/Multiplier, setting standards, mentoring others, and building production-grade systems in Rust while contributing to new product development of complex in-browser applications. Responsibilities also include architecting and implementing complex applications that apply Machine Learning techniques to large data volumes and balancing feature development with technical debt cleanup.
Contribute to backend server-side development to ensure the application is extensible, scalable, and secure. Deliver resilient enterprise software solutions while recognizing and prioritizing customer deliverables and tech debt.
The Senior Content Analyst will interpret healthcare reimbursement policies and translate them into automated claims editing logic. This role involves owning edit concepts from interpretation through validation and ongoing refinement.
The DRG Reviewer will conduct thorough DRG payment validation reviews, including clinical and coding assessments of medical records according to contract-specific criteria. This involves meticulously documenting findings, providing clinical and policy support, and collaborating with stakeholders to ensure compliance with payment standards.
