Healthcare Claims Subject Matter Expert (SME) - Remote

Overview

Machinify is seeking a Subject Matter Expert (SME) for pre and/or post pay data mining to lead in the development, prioritization, and implementation of new ideation on behalf of its customers.

In Short

• Responsible for client growth through monetary and production goals.
• Work with management and clients to plan growth initiatives.
• Collaborate with teams to create comprehensive queries and solutions.
• Develop new auditing concepts related to claims processing.
• Conduct reviews of claims using various resources.
• Serve as a claims billing expert for data teams.
• Refine reimbursement policies in collaboration with the team.
• Stay updated with billing guidelines and regulations.
• Ensure accuracy and quality in auditing concepts.
• Meet production and quality standards.

Requirements

• 10+ years of relevant experience.
• Expertise in healthcare claims, data mining, and client engagement.
• Ability to self-teach and research solutions.
• Experience in reviewing payment information against guidelines.
• Experience or certification in coding/billing is helpful.
• Ability to work in a fast-paced environment.
• Ability to work independently and in a team.
• Strong attention to detail and problem-solving skills.
• Proficiency in productivity and communication tools.
• Flexibility in dealing with change.

Benefits

• Work from anywhere in the US.
• Flexible and trusting work environment.
• Supportive colleagues and leadership.
• Comprehensive medical/dental/vision benefits.
• Competitive salary and equity, 401(k) sponsorship.
• Generous learning and development reimbursement.