Senior Auditor - Pre/Post pay claim (Remote)

Senior Auditor - Pre/Post pay claim (Remote) Machinify is the leading provider of AI-powered software products that transform healthcare claims and payment operations. Each year, the healthcare industry generates over $200B in claims mispayments, creating waste, friction and frustration for patients, providers, and payers. Machinify’s AI-platform enables the company to develop and deploy industry-specific products that increase the speed and accuracy of claims processing. Machinify is seeking a Senior Auditor for pre and/or post pay data mining to conduct claims audits on behalf of Machinify’s customers. The Sr. Auditor will assist in concept ideation, product testing, quality enhancements, and related tasks to ensure customer satisfaction. The ideal candidate has a strong background in healthcare claims auditing, claims processing and coding, with a high level of understanding of CMS and commercial payer payment guidelines. What You/'ll Do Conduct comprehensive reviews of pre and post pay claims using available resources including claims data, client adjudication systems, payment guidelines, and regulatory compliance, contracts, pricing, medical records, authorizations, etc. Serve as a claims billing and payment expert and a resource for data teams and other departments. Develop and refine reimbursement policies and procedures in collaboration with the team. Stay updated with the latest billing guidelines and regulations. Achieve the expected level of accuracy and quality for auditing concepts, including valid claim identification and documentation. Additional responsibilities as assigned to support the business. Identify new payment error concepts and potential claim recoveries; develop high-quality concepts and process improvements, tools, etc. What You/'ll Bring 5+ years of relative experience Ability to review payment information against Medicare and payer billing guidelines to determine payment appropriateness Experience or certification in coding/billing is helpful Ability to meet deadlines Willingness and ability to do what/'s necessary to accomplish workload demands Delivery of high-quality work is critical Strong attention to detail; investigative and deductive reasoning skills Decision-making ability with limited information using reference materials and problem-solving skills Proficiency in Excel, Word, Google Sheets, Slack/messaging platforms Ability to work in a fast-paced environment and adapt to rapid change and growth Preferred Skills Data Mining experience - Post and Pre-pay Payer auditing experience Coding certification What We Offer Work from anywhere in the US! Machinify is digital-first. Flexible and trusting environment with empowerment to do your best work Unlimited PTO Full Medical/Dental/Vision for employees and families with 100% premium coverage options Competitive salary, equity, 401(k) sponsorship Learning and Development reimbursement policy The salary for this position is based on factors including years and depth of experience, set skills, and certifications. The starting salary is 100k+. Our Recruiting team will let you know if you qualify for a different role or range. Salary is one component of the total compensation package, which includes excellent healthcare, flexible time off, and other benefits and perks. Equal Employment Opportunity at Machinify Machinify is committed to hiring talented and qualified individuals with diverse backgrounds for all of its positions. Machinify believes that the gathering and celebration of unique backgrounds, qualities, and cultures enriches the workplace. See our Candidate Privacy Notice at: Seniority level Mid-Senior level Employment type Full-time Job function Accounting/Auditing and Finance Industries Software Development See job alerts for similar roles and locations. Salaries vary by location and experience. #J-18808-Ljbffr

Created: 2025-09-17