Medical Content Analyst, Specialist (Pre-Pay Policy) (AI)

TL;DR

Medical Content Analyst, Specialist (Pre-Pay Policy) (Medtech): Managing clinical content and pre-payment editing rules to prevent inaccurate healthcare payments with an accent on edit logic, content sourcing, and CPT/HCPCS/ICD10CM code set updates. Focus on troubleshooting edit outcomes, resolving client escalations, and bridging the gap between clinical operations and client success.

Location: Remote - Must be based in Pennsylvania and legally authorized to work in the U.S. (Visa sponsorship is not available)

Salary: $125,241 - $187,862

Company

hirify.global is an AI-first healthcare technology company dedicated to reducing waste in the healthcare ecosystem by ensuring pre-payment accuracy.

What you will do

• Advise on clinical content, rules, policies, and configuration options for the ClaimsXten platform.
• Lead client-facing discussions as a subject matter expert to explain edit logic, content sourcing, and expected outcomes.
• Troubleshoot product behavior, including triggers, rule logic, and configuration dependencies.
• Analyze data to assess the impact of content changes and updated CPT/HCPCS/ICD10CM code sets.
• Manage client escalations regarding pre-payment edits and articulate recommended resolution paths.
• Collaborate as a clinical liaison between Clinical Operations, Client Success, and other cross-functional teams.

Requirements

• Bachelor's degree in Nursing, Health Information Management, or a related healthcare field.
• Active AAPC (CPC) or AHIMA (CCS-P/CCS) certification.
• Minimum 12 years of relevant healthcare experience, with 3+ years in payer-side medical policy analysis, claims processing, or clinical editing.
• Minimum 3 years of direct experience with ClaimsXten.
• Must be legally authorized to work in the U.S. without sponsorship.

Nice to have

• Master's degree in business or a healthcare-related field.
• Previous experience as a medical coder or within a Health Insurance plan.
• Deep understanding of US health insurance payers (Commercial, Medicare, Medicaid) and EDI processes.
• Expert-level ability to present complex material across various mediums.
• Proficiency in Microsoft applications.

Culture & Benefits

• Work within an AI-first innovation environment focused on simplifying the business of care.
• Join a market leader recognized as 2025 Best in KLAS for Pre-Payment Accuracy and Integrity.
• Benefit from a HI-TRUST and SOC2 certified organizational structure.
• Experience a candidate-centric culture, evidenced by the 2025 CandE Award for Candidate Experience.
• Inclusive environment that emphasizes empowerment and collaborative success.