Senior Healthcare Data Analyst

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

📋 Description

• Design and execute transformations that convert raw medical and institutional claims into Machinify’s standardized models.

• Implement healthcare coding standards throughout the claims transformation process.

• Conduct audits, troubleshoot, and resolve issues related to data quality and completeness.

• Write SQL and Spark SQL queries to validate the pipeline output from start to finish.

• Gain a deep understanding of Machinify’s platform, covering data ingestion through to claims adjudication.

• Detect patterns of overpayment, coordination-of-benefits challenges, and opportunities for billing edits.

• Apply payer policies, CMS regulations, and methodologies for provider reimbursement.

• Drive the adoption of AI by engaging with and iterating on LLMs.

• Identify manual processes that can be automated and assist in developing AI-enhanced pipelines.

• Aid in the onboarding of new client data feeds and document the transformation logic and lineage.

• Collaborate with data engineers, data scientists, clinical personnel, and product managers to create scalable data solutions.

• Work together with data scientists on advanced analytics and machine learning projects.

• Act as a subject-matter expert in claims coding, adjudication rules, and payer policies.

• Mentor analysts and engineers, providing guidance to stakeholders on risks, trends, and business implications.

⛳️ Requirements

• Bachelor's degree in Business, Computer Science, Health Informatics, or a related discipline.

• Over 5 years of experience directly working with healthcare claims data, including 837 EDI, encounter data, or medical billing.

• Extensive knowledge of professional and institutional claim types, including ICD-10-CM/PCS, CPT, HCPCS, UB-04, and CMS-1500.

• Practical experience in payment integrity, focusing on overpayment detection, COB, billing edits, or claim editing logic.

• Understanding of CMS regulations and commercial payer guidelines for claims adjudication and payment policies.

• Advanced SQL skills and the ability to craft complex analytical queries against large datasets.

• Strong grasp of data modeling concepts and best practices in analytics.

• Capability to discuss healthcare processes and payment logic with health plan clients, clinicians, and non-technical stakeholders.

• Proven ability to manage multiple ongoing initiatives with a strong sense of ownership and accountability.

• Preferred: Familiarity with provider reimbursement methodologies, such as MS-DRG/APR-DRG pricing, fee schedules, per diem, and capitation.

• Preferred: Proficiency in Spark SQL or a similar distributed query engine.

• Preferred: Experience with ETL/ELT pipeline development or collaboration in data engineering.

• Preferred: Knowledge of value-based care arrangements or risk adjustment, including HCC coding and RADV.

🏝️ Benefits

• Work from anywhere in the US; our workplace is digital-first.

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

• A flexible and trusting work environment.

• Unlimited Flexible Time Off (FTO).

• Equity in the company/private equity options.

• 401(k) plan with employer matching contributions.

• Flexible time off along with additional benefits and perks.