Senior Content Analyst (Healthcare Claims)

TL;DR

Senior Content Analyst (Healthcare Claims): Translating healthcare reimbursement policies into automated claims editing logic with an accent on payment accuracy and regulatory compliance. Focus on developing deterministic edits, analyzing claims performance data, and ensuring alignment with CMS and NCCI standards.

Location: Must be based in the US

Company

A leading healthcare intelligence company providing an AI-powered platform to maximize financial outcomes and reduce healthcare costs for health plans.

What you will do

• Interpret CMS, Medicare, Medicaid, and other payer policies to define automated claims editing logic.
• Develop and maintain a proprietary library of claims edits aligned with reimbursement rules and industry standards.
• Create high-quality edit specifications, including logic definitions, assumptions, and validation criteria.
• Analyze claims performance data to reduce false positives and prioritize enhancements by impact.
• Conduct manual claim reviews to validate coding accuracy and policy alignment.
• Collaborate with product, engineering, and implementation teams to ensure correct edit implementation.

Requirements

• 4+ years of experience authoring claims editing content for vendors or payers.
• Deep expertise in CMS policies (LCDs, NCDs), NCCI edits (PTP, MUE), and OIG guidance.
• Proficiency with CPT/HCPCS, ICD-10-CM/PCS, modifiers, and revenue codes.
• Strong understanding of CMS-1500 and UB-04 claims processing workflows.
• Must be based in the US.

Nice to have

• SQL skills for claims analysis or edit opportunity identification.
• Clinical background (RN, BSN, PharmD, MD, or equivalent).

Culture & Benefits

• Digital-first environment with the ability to work from anywhere in the US.
• Comprehensive medical, dental, and vision insurance.
• FSA/HSA options and a solid PTO program.
• 401(k) with company match.
• Tuition reimbursement and additional health and wellness perks.