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Healthcare Audit Policy Analyst (Registered Nurse or Medical Coder)

1 hour, 2 minutes ago
United States
Full-time
Lead
Business Analyst
Data Science and Analytics
Apply Now
Machinify

Machinify

Machinify develops AI-powered software for automated medical treatment review and reimbursement, leveraging cutting-edge technology to revolutionize healthcare processes.

IT Services
51-250
Founded 2016
$10M raised
View All Jobs 2

Description

  • Review, update, and maintain audit concepts in response to client, regulatory, coding, and policy changes.
  • Research and analyze the impact of regulatory, payer policy, and coding changes on existing concepts.
  • Perform QA reviews to validate audit concepts against current coding guidelines, payment methodologies, and payer policies.
  • Manage multiple concurrent audit concept workflows with accuracy and timely delivery.
  • Support audit team policy application across auditing platforms and client programs.
  • Create and maintain training materials, job aids, reference tools, and policy documentation.
  • Respond to client inquiries and support client services with presentations and escalations.
  • Collaborate with operations, clinical, technology, coding, and other stakeholders to improve policy execution and concept quality.
  • Monitor concept performance, analyze data, and recommend changes to improve audit yield and accuracy.
  • Identify and implement process improvements in workflow, documentation, QA, and policy management.

Requirements

  • Bachelor's degree in health administration, business, nursing, or a related field, or equivalent experience.
  • 5+ years of progressive experience in healthcare claim type subject matter specialty, including direct experience in payment integrity and claims auditing.
  • Equivalent experience of 3+ years in claims auditing and recovery auditing.
  • Registered Nurse or Certified Coder with a nationally recognized credential (RHIA, RHIT, AHIMA, AAPC, or equivalent) required.
  • Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, HIPPS, and payment methodologies such as MS-DRG, APR-DRG, APC, APG, PDPM, and PDGM.
  • Deep understanding of Medicare and Commercial coding rules, regulations, prospective payment systems, reimbursement policies, and claim adjudication standards.
  • Experience with data analysis, statistical analysis, and audit concept scoring/selection.
  • Experience developing clinical content, policy documentation, and training resources.
  • Advanced proficiency in Microsoft Office, especially Excel and PowerPoint, plus Word, Outlook, SharePoint, and Teams.
  • Familiarity with multiple encoder/grouper applications and experience working with software platforms and development teams.
  • Proven ability to work independently in a remote environment and manage multiple concurrent workflows.
  • Excellent written and verbal communication, critical thinking, and attention to detail.

Benefits

  • Work from anywhere in the US in a digital-first environment.
  • Top medical, dental, and vision coverage.
  • FSA/HSA options.
  • Tuition reimbursement.
  • Competitive salary of $80,000 - $120,000.
  • 401(k) with company match.
  • Additional health and wellness benefits and perks.
  • Flexible and trusting work environment.

Interested in this position?

Apply directly on the company website

Apply Now

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