Content Innovation, Claims Editing - NY Medicaid (Multiple Levels)

The posting, as Machinify wrote it

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.

About the Opportunity

Machinify is redefining Payment Integrity through smarter technology, richer data, and intelligent automation. We are seeking a claims editing content expert to help build the next generation of editing content and make healthcare payments more accurate and affordable. This role will bring deep expertise in New York State Medicaid.

As Content Innovation, Claims Editing - NY Medicaid you will source, design, validate, and maintain the clinical and coding content that powers our editing products. You will find opportunities in policy and in the data, turn them into edits that hold up, and measure whether they deliver value for our health plan clients. Your focus will be New York State Medicaid , where you will be our go-to expert on state policy and how it shapes editing.

This is a build-and-scale role at the intersection of clinical editing, coding, reimbursement policy, data science, and product development. The ideal candidate brings deep clinical editing and coding expertise, a strong analytical instinct, and an open, practical interest in how AI can help us build better content, faster, while keeping quality and clinical accuracy at the center.

You do not need to be a data scientist. You do need to think in terms of evidence, measurable outcomes, and the value each edit creates for a client.

What you’ll do

Source and author editing content

• Monitor and interpret authoritative sources, including CPT and HCPCS updates, ICD-10-CM guidelines, NCCI PTP and MUE tables, CMS manuals, NCDs and LCDs, specialty society guidance, and payer reimbursement policies.
• Translate coding rules, clinical guidelines, and reimbursement policy into precise, testable editing logic.
• Document the source, rationale, and scope of every edit so it is traceable, defensible on appeal, and easy to maintain.
• Separate portable, market-wide content from client-specific policy, and flag the difference clearly in all content and sizing work.
• Maintain existing content through quarterly code updates, policy changes, and performance reviews, and recommend when edits should be refined or retired.

Bring depth in New York State Medicaid

• Monitor and interpret New York Medicaid sources, including eMedNY provider manuals and fee schedules, NYS DOH Medicaid Update, Medicaid Managed Care contract requirements, and OMIG guidance.
• Translate N

[…]
st state policy; and deliver a prioritized list of New York content gaps and opportunities.

Within 6 to 12 months

You will own a content domain end to end, move multiple data-validated concepts into production, maintain accurate and current source documentation, contribute to at least one AI-assisted improvement in how content is built, set up a repeatable process for tracking New York policy changes, and show measurable results in edit accuracy, speed, or client value.

Pay range : $135,000 - $165,000 USD

This exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.

What’s in it for you

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

What values we’ll share with you

• Ask why
• Think big
• Be humble
• Optimize for customer impact
• Deliver results

Equal Employment Opportunity at Machinify

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/