Healthcare Audit Policy Analyst (Registered Nurse or Medical Coder)

Machinify
United States
Workplace: RemoteFull timeUSD 80,000 - 120,000 annuallyFunction: Government Affairs & Public PolicyEducation: bachelorsSkills: ["Analytical thinking","Attention to detail","Communication","Critical thinking","Managing complex workflows"]

Lead the development, maintenance, testing, and optimization of payment integrity audit concepts across government and commercial claim types. You’ll review and update audit policies and code lists, perform QA validation against coding and payer rules, monitor concept performance with statistical analysis, and resolve discrepancies with clinical and operations teams. You’ll also create training and reference materials and support client service inquiries, using ICD-10, CPT/HCPCS, and Medicare/Commercial payment methodologies.

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FursaFursa
Machinify
Machinify
1 month ago

Healthcare Audit Policy Analyst (Registered Nurse or Medical Coder)

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 4 hours agoStatus: Live

Job Summary

Lead the development, maintenance, testing, and optimization of payment integrity audit concepts across government and commercial claim types. You’ll review and update audit policies and code lists, perform QA validation against coding and payer rules, monitor concept performance with statistical analysis, and resolve discrepancies with clinical and operations teams. You’ll also create training and reference materials and support client service inquiries, using ICD-10, CPT/HCPCS, and Medicare/Commercial payment methodologies.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Government Affairs & Public Policy
Seniority: Mid level

Key Responsibilities

  • •Review and update audit concepts on periodic cycles and in response to client or regulatory changes using research and data/claim analysis.
  • •Perform QA reviews and validate audit concepts against coding guidelines, payment methodologies, and payer policy prior to deployment.
  • •Manage multiple concurrent audit concept workflows with high accuracy and deliver results on time.
  • •Contribute to creation of training materials, job aids, and documentation for audit policies and concept updates.
  • •Respond to client inquiries and collaborate with operations, clinical, technology, and internal stakeholders to support policy execution and resolve discrepancies.

Pay and Benefits

Salary: USD 80,000 - 120,000 annually
Perks:Health InsuranceDentalVisionFsa/hsa401kLearning Budget

Key Requirements

  • •Bachelor’s degree in health administration, business, nursing, or a related field, or equivalent experience.
  • •5+ years progressive experience in healthcare claim type subject matter specialty, including 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.
  • •Deep knowledge of Medicare and Commercial coding rules, regulations, and prospective payment systems, plus payment methodologies and audit concept development across claim types.
Experience:HealthcareHealthcare claimsPayment integrityMedical codingHealth plansMedicareMedicaidCommercial healthcare
Education:Bachelor's in health administration, business, nursing, or a related field
Skills:Analytical thinkingAttention to detailCommunicationCritical thinkingManaging complex workflows
Certifications:RHIARHITAHIMAAAPC
Languages:English
Tech Stack:Microsoft ExcelMicrosoft WordMicrosoft OutlookMicrosoft PowerPointSharePointMicrosoft TeamsWindowsEncoder/grouper applications

Company Brief

Machinify
Provides AI-driven predictive maintenance and asset-monitoring solutions for manufacturing and industrial operations, using IoT sensor data and machine learning to reduce downtime, optimize performance, and extend equipment life.
Industry: Industrial Automation
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