IBR Policy and Content Development Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Develop, enhance, and sustain clinical and coding payment integrity solutions.

• Regularly review and update audit concepts or in response to client or regulatory changes, which includes research, data/claim analysis, rule-document updates, and code-list revisions.

• Conduct research and analyze the effects of regulatory, coding, or payer-policy changes on existing concepts, documenting the findings.

• Interpret and apply client-specific payer policies during audit concept reviews and updates.

• Integrate state-specific Medicare/Medicaid provider manuals and regional regulatory mandates into audit concept configurations.

• Assess payer policies to identify gaps and recommend new audit concepts to clients.

• Ensure that audit concepts are accurately formulated across Medicaid, Medicare, and Commercial programs.

• Align concepts with CMS, MUEs, CPT/HCPCS coding guidelines, and NCCI edits.

• Detect discrepancies in concept performance and facilitate resolutions with clinical, coding, and operations teams.

• Benchmark concept outcomes against industry standards, historical data, and client baselines.

• Test new concepts to validate automated logic prior to implementation.

• Confirm concepts against coding guidelines, payment methodologies, and payer policies before deployment.

• Ensure consistent application of policies across platforms and client programs.

• Collaborate with operations, clinical, client services, and IT teams on coding solutions, audit strategies, and payment integrity initiatives.

• Enhance audit concept workflows, documentation, tracking, and cross-functional coordination.

• Leverage AI tools and automation to optimize policy development, streamline research, and scale solution performance.

• Undertake additional responsibilities and ad hoc projects as needed.

⛳️ Requirements

• Minimum of 3 years’ experience in payment integrity or auditing facility claims.

• Experience in converting complex medical regulations and payer guidelines into clear, legally compliant clinical content and structured policy documentation.

• Profound understanding of Medicare and Commercial coding rules, regulations, and prospective payment systems.

• Extensive knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.

• Familiarity with national coding standards, especially payment rules.

• Exceptional organizational and written communication skills.

• Comprehensive knowledge of various facility reimbursement methodologies and commercial/government payment policies to ensure accurate contract compliance and audit integrity.

• Proficient in Windows office systems, including the entire Microsoft Suite (Excel, Word, Outlook, PowerPoint, SharePoint, and Teams).

• Proven experience or proficiency in using AI tools and automation platforms to enhance clinical research.

• Established ability to communicate effectively with all organizational levels, diverse teams, and clients.

• Capability to prioritize tasks and manage multiple responsibilities.

• At least one of the following coding certifications: RHIA, RHIT, CCS, CPC, CPMA.

• Alternatively, an active RN/LPN License.

🏝️ Benefits

• Work from anywhere in the US! Machinify is digital-first.

• Comprehensive Medical/Dental/Vision offerings.

• Flexible Spending Account (FSA) and Health Savings Account (HSA).

• Tuition reimbursement.

• Competitive salary.

• 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.