Payment Integrity Concept Development Analyst - Outpatient
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
Required credential: Active RN license or Certified Coder (CPC/CCS/CIC/COC).
As part of the Complex Payment Solutions Team, the Concept Development Analyst applies subject matter expertise across government and commercial healthcare claim types to lead the development, maintenance, testing, and optimization of payment integrity audit concepts. This role works closely with cross-functional teams — including operations, clinical, client services, and technology — to ensure audit concepts are accurately built, validated, and maintained in alignment with coding standards, medical necessity criteria, regulatory requirements, and client
