[Remote] Data Mining Sr. Analyst

Note: The job is a remote job and is open to candidates in USA. Machinify is seeking a Senior Analyst to develop and refine reimbursement and payment integrity concepts. The role uses healthcare reimbursement and contract expertise to identify payment errors, translate findings into structured business logic, and partner with technical teams on analytics and automation.

Responsibilities

• Lead pre and post-pay claim reviews to identify inaccurate payments using reimbursement and contract expertise
• Analyze and interpret provider contracts to ensure payments align with negotiated terms, methodologies, and payer rules
• Collaborate closely with engineering and data science teams to translate business and reimbursement logic into analytical and automation frameworks
• Research and document emerging reimbursement and contract patterns, coverage rules, and billing practices to inform concept development
• Translate complex reimbursement and contract scenarios into structured rules and business logic for implementation
• Analyze claim-level data to pinpoint root causes of overpayments or incorrect denials and recommend corrective approaches
• Maintain expertise on CMS and commercial payer reimbursement guidelines
• Support quality review, concept validation, and process improvement initiatives

Skills

• 5+ years of experience in healthcare data mining or claims editing on the provider, payer, or vendor side
• Deep understanding of provider contracts, including rate structures, carve-outs, and reimbursement methodologies
• Strong knowledge of claims processing, coding, billing, and payment logic across CMS and commercial payers
• Proven ability to identify improper payment patterns, root causes, and opportunities for correction
• Strong investigative and deductive reasoning skills; able to connect policy, data, and contractual details
• Comfortable working in close collaboration with technical teams to guide implementation of business logic
• Self-directed, detail-oriented, and adaptable to a fast-paced, growing environment
• Coding certification (e.g., CPC, CCS, or equivalent)
• Working proficiency in SQL for data exploration and validation
• Prior experience in cross-functional R&D or innovation teams focused on healthcare payment integrity

Benefits

• Work from anywhere in the US! Machinify is digital-first.
• Top Medical/Dental/Vision offerings
• FSA/HSA
• Tuition reimbursement
• 401(k) with company match
• Additional health and wellness benefits and perks
• Flexible and trusting environment where you’ll feel empowered to do your best work

Company Overview

Company H1B Sponsorship