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

Machinify is redefining Payment Integrity through smarter technology, richer data, and intelligent automation. We are seeking a claims editing content expert to help build the next generation of editing content and make healthcare payments more accurate and affordable. This role will bring deep expertise in New York State Medicaid.

As Content Innovation, Claims Editing - NY Medicaid you will source, design, validate, and maintain the clinical and coding content that powers our editing products. You will find opportunities in policy and in the data, turn them into edits that hold up, and measure whether they deliver value for our health plan clients. Your focus will be New York State Medicaid, where you will be our go-to expert on state policy and how it shapes editing.

This is a build-and-scale role at the intersection of clinical editing, coding, reimbursement policy, data science, and product development. The ideal candidate brings deep clinical editing and coding expertise, a strong analytical instinct, and an open, practical interest in how AI can help us build better content, faster, while keeping quality and clinical accuracy at the center.

You do not need to be a data scientist. You do need to think in terms of evidence, measurable outcomes, and the value each edit creates for a client.

What you’ll do

Source and author editing content

Monitor and interpret authoritative sources, including CPT and HCPCS updates, ICD-10-CM guidelines, NCCI PTP and MUE tables, CMS manuals, NCDs and LCDs, specialty society guidance, and payer reimbursement policies.
Translate coding rules, clinical guidelines, and reimbursement policy into precise, testable editing logic.
Document the source, rationale, and scope of every edit so it is traceable, defensible on appeal, and easy to maintain.
Separate portable, market-wide content from client-specific policy, and flag the difference clearly in all content and sizing work.
Maintain existing content through quarterly code updates, policy changes, and performance reviews, and recommend when edits should be refined or retired.

Bring depth in New York State Medicaid

Monitor and interpret New York Medicaid sources, including eMedNY provider manuals and fee schedules, NYS DOH Medicaid Update, Medicaid Managed Care contract requirements, and OMIG guidance.
Translate New York reimbursement rules, including APG and APR-DRG methodologies, into editing logic, alongside federal Medicaid NCCI PTP and MUE edits.
Build content for the programs and provider types that matter most to New York plans, such as Mainstream Managed Care, HARP, behavioral health, FQHC, and long-term care services.
Track New York policy changes and keep state content current.

Validate content with data

Use claims data to test editing concepts before build, size the opportunity, and estimate hit rate, false-positive rate, and savings.
Review edit output and production results to confirm edits fire as intended and to find gaps, over-reach, or missed opportunities.
Track measures such as accuracy, hit rate, false positives, appeals, overturns, provider abrasion, and realized savings.
Bring an analytical, value-first view to prioritization: what is the opportunity, how confident are we, and what will it return for the client?

Partner with Product and Data Science

Work with Product, Engineering, and Data Science to turn content concepts into clear requirements, logic specifications, and test cases.