Machinify offers AI-powered healthcare payment integrity solutions to enhance claims accuracy, recovery performance, and cost control. Backed by Battery and GV.
About the role
As part of the Complex Payment Solutions (CPS) Team, the Audit Policy Analyst, Post-Acute Services serves as the subject matter expert for durable medical equipment (DME), home health, and home infusion therapy claims across government and commercial lines of business. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- Deep understanding of Medicare home health conditions of payment, including homebound status, face-to-face encounter, certification and recertification, plan of care, OASIS assessment, and the Notice of Admission
- Broad knowledge of provider billing guidelines, payer reimbursement policies, medical necessity criteria, and claim adjudication standards for post-acute services
- Expert knowledge of clinical documentation requirements and audit concept development for post-acute claim types
- Strong experience in data utilization and statistical analysis, including driving scoring and selection for audit concepts
- Progressive healthcare data analysis experience, including gathering and documenting requirements for projects of diverse scope and complexity
- Experience developing clinical content, policy documentation, and training resources
More about this role
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.
As part of the Complex Payment Solutions (CPS) Team, the Audit Policy Analyst, Post-Acute Services serves as the subject matter expert for durable medical equipment (DME), home health, and home infusion therapy claims across government and commercial lines of business. This role leads the development, maintenance, testing, and optimization of post-acute payment integrity audit concepts and partners with operations, clinical, client services, and technology teams to ensure each concept is built, validated, and maintained in alignment with coding standards, coverage and medical...
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