IBR Policy and Content Development Analyst

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

About the Opportunity 

We’re seeking a skilled IBR Policy and Content Development Analyst to join our team! You will be responsible for the development, enhancement, and performance of clinical and coding solutions. This role serves as the primary subject matter expert for payment integrity policies, leveraging expertise in healthcare payment policies, facility billing, coding, and regulatory requirements. This role works closely with cross-functional teams – including operations, clinical, client services, and IT – to ensure audit concepts are accurately built, validated, and maintained in alignment with coding standards, medical necessity criteria, and client-specific payer policies.

The ideal candidate will possess extensive knowledge in medical coding systems and payment methodologies, as well as have strong analytical and communication skills.  The candidate brings a proven track record of leading audit concept development and driving payment integrity initiatives.

What You’ll Do

• Review and update existing audit concepts on required regular cycles or in response to client or regulatory changes, including research, data/claim analysis, and updates to rule documents and code lists.
• Conduct research and analysis to identify the impact of regulatory, coding, or payer policy changes on existing concepts and document findings accordingly.
• Interpret and apply client-specific payer policy in audit concept reviews and updates.
• Research, interpret, and embed state-specific Medicare/Medicaid provider manuals and regional regulatory mandates into audit concept configurations.
• Evaluate payer policies to proactively identify gaps and propose new, audit concepts to clients.
• Ensure audit concepts are appropriately formulated across offering types and program lines (Medicaid, Medicare, Commercial).
• Align concepts with industry standards, including CMS, MUEs, and CPT/HCPCS coding guidelines.
• Develop, validate, and maintain audit concepts targeting coding unbundling in accordance with NCCI edits.
• Identify discrepancies in concept performance and drive resolution with clinical, coding, and operations teams.