IBR Policy and Content Development Analyst (Healthcare)

Location: Remote within the United States

Base salary: $85,000–$110,000 annually

Company

hirify.global provides an AI-powered healthcare intelligence platform and payment integrity solutions for health plan clients.

What you will do

• Develop, enhance, validate, and maintain clinical and coding audit concepts across Medicaid, Medicare, and Commercial programs.
• Research regulatory, coding, and payer policy changes and update rule documents, code lists, and policy configurations.
• Interpret state-specific Medicare and Medicaid provider manuals, regional mandates, medical necessity criteria, and client-specific payer policies.
• Analyze concept performance, benchmark outcomes, identify gaps, and resolve discrepancies with clinical, coding, operations, and IT teams.
• Test automated audit logic before deployment and confirm alignment with CMS, MUEs, CPT/HCPCS, NCCI edits, and payment methodologies.
• Use AI tools and automation to improve policy research, documentation, workflows, and payment integrity performance.

Requirements

• At least 3 years of experience in payment integrity or facility claims auditing.
• Strong knowledge of Medicare and Commercial coding rules, reimbursement methodologies, provider billing, payer policies, medical necessity criteria, and payment systems.
• Experience translating medical regulations and payer guidelines into compliant clinical content and structured policy documentation.
• At least one of the following certifications: RHIA, RHIT, CCS, CPC, or CPMA; alternatively, an active RN or LPN license.
• Proficiency with Microsoft Office systems, including Excel, Word, Outlook, PowerPoint, SharePoint, and Teams.
• Strong analytical, organizational, written communication, prioritization, and cross-functional collaboration skills.

Culture & Benefits

• Digital-first environment with flexible and trusting work practices.
• Medical, dental, and vision coverage.
• FSA/HSA options and additional health and wellness benefits.
• Tuition reimbursement.
• 401(k) with company match.