Content Innovation, Claims Editing (Healthcare AI)

Location: Remote - US; remote and hybrid work options are available.

Base salary: $135,000–$165,000 USD per year.

Company

hirify.global is a healthcare intelligence company providing an AI-powered payment integrity platform for health plans.

What you will do

• Source and author clinical, coding, and reimbursement-policy content for claims editing products.
• Translate coding rules, clinical guidelines, and payer policies into precise, testable editing logic.
• Validate editing concepts and production results with claims data, measuring hit rates, false positives, appeals, overturns, provider abrasion, and realized savings.
• Maintain content through code updates, policy changes, and performance reviews, and recommend refinements or retirement of edits.
• Partner with Product, Engineering, and Data Science on requirements, logic specifications, test cases, and clinical context.
• Support client policy reviews, edit approvals, appeals, and explanations of content rationale and expected impact.

Requirements

• 7+ years of experience in claims editing, clinical coding, Payment Integrity, or payer policy, including hands-on edit authoring or validation.
• Active coding credential such as CPC, CCS, CCS-P, CPMA, or CIC, or a clinical license such as RN combined with deep coding experience.
• Current knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI, MUEs, coding guidelines, documentation requirements, and reimbursement methodologies.
• Experience interpreting CMS manuals, NCDs, LCDs, AMA guidance, and payer policies.
• Strong analytical skills and experience using claims data, SQL, Excel, or similar tools to test hypotheses and measure results.
• Experience collaborating with Product, Engineering, Data Science, or other multidisciplinary teams, with clear written communication for nonclinical audiences.

Nice to have

• Experience in claims editing, Payment Integrity, or healthcare technology.
• Experience across commercial, Medicare Advantage, and Medicaid lines of business.
• Clinical background with direct patient care experience.
• Experience writing product requirements or logic specifications for engineering teams.
• Experience with Python, SQL, BI tools, or presenting content rationale and savings analyses to health plan clients.

Culture & Benefits

• Remote and hybrid work options.
• PTO, paid holidays, and volunteer days.
• Eligibility for health, vision, dental, 401(k) with company match, and flexible spending accounts.
• Tuition reimbursement and company-paid life insurance, short-term disability, and parental leave.
• Values include asking why, thinking big, humility, customer impact, and delivering results.