Senior Data Analyst
New
M
MachinifyHealthcare Intelligence
Remote - USFull-TimeSenior
Salary$140,000-$170,000
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Job Details
- Experience
- 5+ years
- Required Skills
- SQLData AnalysisETLDatabricks
Requirements
- 5+ years of data analysis experience working directly with healthcare claims data.
- Deep knowledge of medical claim types (professional and institutional) and coding systems (ICD-10-CM/PCS, CPT, HCPCS, UB-04, CMS-1500).
- Expert-level SQL skills including window functions, CTEs, and performance tuning against datasets of hundreds of millions of rows.
- Demonstrated experience using LLMs or AI tools to accelerate analytical work as a repeatable part of your workflow.
- Hands-on payment integrity experience (overpayment detection, COB, billing edits, or claim editing logic).
- Familiarity with CMS regulations and commercial payer guidelines as they apply to claims adjudication and payment policy.
- Proficiency with Spark SQL or a comparable distributed query engine.
- Experience with Databricks or a cloud data lakehouse (Delta Lake, Snowflake, BigQuery).
- Background in ETL/ELT pipeline development or close collaboration with data engineers on pipeline design.
- Working knowledge of provider reimbursement methodologies including MS-DRG/APR-DRG pricing, fee schedules, per diem, and capitation.
- Strong communication skills for discussing healthcare process and payment logic with health plan clients and non-technical stakeholders.
Responsibilities
- Collaborate with clients and internal stakeholders to understand payment integrity requirements, document process flows, and integrate analytical outputs with client workflows and downstream adjudication systems.
- Develop deep understanding of Machinify's internal processes and how they integrate together, from data ingestion through claims adjudication.
- Actively drive AI adoption by prompting and iterating with LLMs to accelerate analysis and identify processes where AI can replace manual workflows.
- Write and maintain complex analytical SQL against large-scale claims datasets, including window functions, CTEs, and multi-table joins.
- Identify and build AI-driven automation workflows to replace or accelerate manual analytical processes.
- Design and implement data transformations that convert raw medical and institutional claims into canonical models applying healthcare coding standards.
- Drive payment integrity analysis by identifying overpayment patterns, coordination of benefits issues, and billing edit opportunities.
- Mentor analysts and engineers on healthcare domain questions, serving as the subject matter expert on coding, claims adjudication, and payer policy.
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