Senior Data Analyst

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

📋 Description

• Collaborate with clients and internal stakeholders to comprehend payment integrity requirements, document process flows, and integrate analytical outputs with client workflows and downstream adjudication systems.

• Gain a thorough understanding of Machinify's internal processes and their interconnections — from data ingestion to claims adjudication — ensuring that analytical solutions are accurate, traceable, and aligned with business objectives.

• Proactively promote AI adoption: engage with LLMs to enhance analysis, pinpoint processes where AI can supersede manual workflows, and contribute to the development of AI-assisted pipelines.

• Write and maintain complex analytical SQL against extensive claims datasets: utilizing window functions, CTEs, multi-table joins, query optimization, and production-quality logic that performs reliably at scale.

• Identify and establish AI-driven automation workflows that replace or expedite manual analytical processes — transitioning from one-off prompts to repeatable, team-shareable tools.

• Design and implement data transformations that convert raw medical and institutional claims into standardized models, adhering to healthcare coding standards (ICD-10, CPT, HCPCS, UB-04, CMS-1500) throughout the process.

• Lead payment integrity analysis — identify overpayment trends, coordination of benefits issues, and billing edit opportunities by leveraging in-depth knowledge of payer policies, CMS regulations, and provider reimbursement methodologies.

• Perform data quality audits and create monitoring frameworks that highlight anomalies before they reach production.

• Facilitate the onboarding of new client data feeds, ensuring seamless integration with minimal disruption.

• Collaborate with engineers, clinical staff, and product managers to translate complex healthcare requirements into effective data solutions.

• Mentor analysts and engineers on healthcare domain inquiries — acting as the primary SME on coding, claims adjudication, and payer policy.

• Document transformation logic, data lineage, and analytical methodologies to support knowledge transfer and ensure audit readiness.

⛳️ Requirements

• Over 5 years of experience in data analysis, particularly working directly with healthcare claims data.

• Extensive knowledge of medical claim types (both professional and institutional), coding systems (ICD-10-CM/PCS, CPT, HCPCS), and standard form formats (UB-04, CMS-1500).

• Proven experience in utilizing LLMs or AI tools to enhance analytical tasks — not merely as a novelty, but as a consistent element of your workflow.

• Expert-level SQL proficiency: capable of executing complex analytical queries, window functions, CTEs, and performance tuning against datasets comprising hundreds of millions of rows.

• Practical experience in payment integrity: overpayment detection, COB, billing edits, or claims editing logic.

• Knowledge of CMS regulations and commercial payer guidelines relevant to claims adjudication and payment policies.

• Strong communication skills — able to articulate healthcare processes and payment logic directly with health plan clients and non-technical stakeholders.

• Ability to translate vague business and clinical requirements into clear, well-documented data logic.

• Familiarity with provider reimbursement methodologies — including MS-DRG/APR-DRG pricing, fee schedules, per diem, and capitation.

• Proficiency in Spark SQL or a similar distributed query engine — writing and optimizing queries against large-scale data environments is a daily expectation.

• Experience with Databricks or a cloud data lakehouse (Delta Lake, Snowflake, BigQuery).

• Background in ETL/ELT pipeline development or close collaboration with data engineers on pipeline design.

• Exposure to value-based care arrangements or risk adjustment (HCC coding, RADV).

• Prior experience at a health plan, payment integrity vendor, or healthcare analytics firm.

🏝️ Benefits

• Work from anywhere in the US! Machinify embraces a digital-first approach.

• Comprehensive Medical/Dental/Vision coverage for employees and their families.

• A flexible and trusting environment that empowers you to perform at your best.

• Unlimited Flexible Time Off (FTO).

• Competitive salary, equity, and a 401(k) plan that includes employer matching.