Current jobs related to Senior Medical Claims Auditor - Palo Alto, California - Machinify

  • Clinical Validation Auditor

    4 days ago

    Palo Alto, California, United States Elevance Health Full time

    Job DescriptionDiagnosis Related Group Clinical Validation AuditorLocation: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our locations.The Diagnosis Related Group Clinical Validation Auditor is responsible for auditing inpatient medical records to ensure clinical documentation supports the...

  • Senior Financial Analyst

    4 weeks ago

    Palo Alto, California, United States Pinpoint Talent Full time

    Job Opportunity for Senior AccountantPinpoint Talent is seeking a highly skilled Senior Accountant to join our team.The ideal candidate will have 3-5 years of experience in property accounting, with a strong understanding of US GAAP accounting principles. They will be responsible for managing financial reporting and accounting processes for a diverse...

  • Senior Financial Analyst

    2 weeks ago

    Palo Alto, California, United States Navan Full time

    Senior Technical Accountant Job DescriptionWe are seeking a highly skilled Senior Technical Accountant to join our Navan Technical Accounting and Financial Reporting team. As a Senior Technical Accountant, you will play a critical role in delivering timely and accurate financial reporting.Key Responsibilities:Assist in the planning and execution of quarterly...

  • Senior Data Science Leader

    2 weeks ago

    Palo Alto, California, United States Machinify Full time

    Job OverviewMachinify is a leading provider of AI-powered software products that transform healthcare claims and payment operations. Our platforms leverage cutting-edge NLP and traditional ML to help clinicians make complex decisions. However, the real challenge lies ahead; moving from "AI Assistant" to human-caliber interpretation of both claim data and...

  • Senior Engineering Director

    1 week ago

    Palo Alto, California, United States Machinify Full time

    About the RoleMachinify is a leading provider of AI-powered software products that transform healthcare claims and payment operations. Our innovative platform has enabled us to develop and deploy industry-specific products that increase the speed and accuracy of claims processing by orders of magnitude.We are seeking a Senior Engineering Director to lead our...

  • Senior Data Scientist

    1 week ago

    Palo Alto, California, United States Machinify Full time

    Job OverviewMachinify is a leading provider of AI-powered software products that transform healthcare claims and payment operations. Our revolutionary AI-platform enables us to develop and deploy industry-specific products that increase the speed and accuracy of claims processing by orders of magnitude.We are seeking a Data Scientist, a proven AI...

  • Senior Living Sales Director

    2 weeks ago

    Palo Alto, California, United States Oakmont Senior Living Full time

    Sales and Marketing Director OpportunityWe are seeking a highly skilled Sales and Marketing Director to join our team at Oakmont Senior Living. As a key member of our leadership team, you will be responsible for driving sales growth and developing strategic marketing plans to achieve occupancy targets.Key Responsibilities:Develop and execute a comprehensive...

  • Senior Accounting Director

    3 weeks ago

    Palo Alto, California, United States Vaco Full time

    Senior Accounting Manager Job DescriptionVaco is seeking an experienced Senior Manager of Accounting to join our team. This role is based in San Mateo, CA, with in-office work required on Tuesday, Wednesday, and Thursday, and optional in-office work on Monday and Friday.Key Responsibilities:Lead the execution of the month-end close process for the GL Team,...

  • Senior Living Sales and Marketing Director

    1 week ago

    Palo Alto, California, United States Oakmont Senior Living Full time

    Sales and Marketing Director OpportunityWe are seeking a highly motivated and experienced Sales and Marketing Director to join our team at Oakmont Senior Living. As a key member of our leadership team, you will be responsible for developing and implementing a strategic marketing plan to drive occupancy and revenue growth.Key Responsibilities:Develop and...

  • Financial Operations Manager

    4 weeks ago

    Palo Alto, California, United States Creative Financial Staffing Full time

    Assistant Controller Job SummaryWe are seeking an experienced Assistant Controller to join our team at Creative Financial Staffing. The successful candidate will be responsible for ensuring compliance with company policies and government regulations, maintaining banking and cash management practices, and providing financial analysis in support of new...

  • Senior Software Engineer

    3 days ago

    Palo Alto, California, United States Machinify Full time

    About the RoleMachinify is a leading provider of AI-powered software products that transform healthcare claims and payment operations. We're seeking a high-level Senior Software Engineer to join our team and contribute to the development of innovative solutions that increase the speed and accuracy of claims processing.The ideal candidate has a range of...

  • Senior Director of Accounting

    4 weeks ago

    Palo Alto, California, United States EK Recruiting Full time

    About the JobSenior Director, AccountingCompensation and BenefitsThe salary range for this position is $210k to $250k. Factors such as academic credentials and relevant experience will influence the actual salary offered. -Comprehensive benefits package, including 401k with matching. -Opportunity to participate in equity/stock incentive programs...

  • Senior Accounting Manager

    2 weeks ago

    Palo Alto, California, United States Vaco Full time

    Senior Accounting Manager Job DescriptionVaco is seeking an experienced Senior Accounting Manager to join our team. As a key member of our accounting department, you will be responsible for leading the execution of the month-end close process, mentoring and developing a team of accounting professionals, and performing technical accounting research.Key...

  • Caregivers Wanted for Senior Care

    1 month ago

    Palo Alto, California, United States Forget Me Not Senior Services Full time

    We are seeking experienced and compassionate caregivers to care for our senior clients. If you are looking for a rewarding career making a difference in the lives of our senior community, we would love to speak with you.Hiring Process:We are committed to getting you in our door as quickly as possible. Be prepared for interviews and attend orientation within...

  • Senior Director, Medical Strategy

    2 weeks ago

    Palo Alto, California, United States Guardant Health Full time

    Job Title: Senior Director, Medical StrategyGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through the use of its proprietary tests, vast data sets, and advanced analytics. We are seeking a highly experienced Senior Director, Medical Strategy to lead our medical affairs activities within the oncology...

  • Senior Clinical Marketing Manager

    3 days ago

    Palo Alto, California, United States Hyperfine Full time

    Job Title:Senior Clinical Marketing ManagerThe Senior Clinical Marketing Manager is responsible for developing and implementing clinical marketing strategy and plans, creating clinical marketing materials, and managing professional education programs.This person will work closely with several cross-functional partners, including the Clinical team, field...

  • Senior Data Engineer

    1 week ago

    Palo Alto, California, United States Machinify Full time

    Job OverviewMachinify is a leading provider of AI-powered software products that transform healthcare claims and payment operations. Our revolutionary AI-platform enables us to develop and deploy industry-specific products that increase the speed and accuracy of claims processing by orders of magnitude.We are seeking a Senior Data Engineer to build and own...

  • Senior Director, National Field Medical Affairs, Oncology

    3 weeks ago

    Palo Alto, California, United States Guardant Health Full time

    Job DescriptionGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through the use of its proprietary tests, vast data sets, and advanced analytics. The company's oncology platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes, and lower healthcare costs across all stages...

  • Senior Financial Planning Analyst

    2 weeks ago

    Palo Alto, California, United States Recor Medical Full time

    Senior Analyst, Financial Planning & AnalysisAt Recor Medical, we are pioneering Ultrasound Renal Denervation (uRDN) therapy to treat hypertension, a leading cardiovascular risk factor worldwide.We are seeking a Senior Analyst, Financial Planning & Analysis (FP&A) who will report to the Sr. Manager of Corporate FP&A.Key Responsibilities:Provide end-to-end...

  • Business Development Manager Litigation

    4 weeks ago

    Palo Alto, California, United States Wilmerhale Full time

    Job SummaryThis is a contingent hire mid-level professional position that will perform medical record and claims review for Medicare, Medicaid, and/or other claims data in order to ensure that proper guidelines have been followed.Key ResponsibilitiesReview Explanation of Benefit (EOB) cases, beneficiary, provider, and/or pharmacy cases for drug seeking, drug...

Senior Medical Claims Auditor

2 months ago

Palo Alto, California, United States Machinify Full time
Position Overview

Machinify, a pioneering healthcare technology firm, is dedicated to ensuring that patients receive optimal medical care at the appropriate time and cost. Our innovative cloud-based AI platform harnesses cutting-edge advancements in machine learning, data analytics, and cloud computing to address complex challenges in healthcare administration and payment processes.

We are currently in search of a Senior Medical Claims Auditor to spearhead post-payment data analysis and perform claims audits for our clients. This role will also involve contributing to concept development, product evaluation, quality improvements, and other related initiatives to enhance client satisfaction.

The ideal candidate will possess a robust background in healthcare claims auditing, processing, and coding, along with a comprehensive understanding of payment regulations for CMS, Medicaid, and commercial insurers.

Key Responsibilities:

  • Innovate auditing methodologies by leveraging expertise in the claims payment cycle, contractual agreements, policies, and regulations.
  • Execute thorough evaluations of post-payment claims utilizing all available resources, including data and client adjudication systems, compliance with regulatory standards, pricing frameworks, medical documentation, and authorizations.
  • Act as a knowledgeable resource in claims billing and payment for data teams and other departments.
  • Collaborate with the team to develop and enhance reimbursement policies and procedures.
  • Stay informed about the latest healthcare billing guidelines and regulations.
  • Meet the accuracy and quality benchmarks established by clients for auditing concepts, ensuring valid claim identification and documentation.
  • Identify potential claims beyond the current concepts where additional recoveries may be feasible. Propose and create high-quality, high-value concepts and process improvements.
  • Undertake additional responsibilities as necessary to support business objectives.

Required Qualifications:

  • A minimum of 10 years of relevant experience in medical coding and claims auditing.
  • Proficient in analyzing payment data against Medicare and payer billing standards to evaluate payment accuracy and appropriateness.
  • Ability to deliver high-quality work in a fast-paced and dynamic environment.
  • Exceptional attention to detail; strong investigative and analytical skills are essential.
  • Capable of thriving in an autonomous work setting while managing competing priorities.
  • Strong decision-making skills, particularly when working with limited information, utilizing reference materials and problem-solving abilities.
  • Proficient in productivity tools (e.g., Excel, Word, Google Suite); intermediate spreadsheet skills, including formula usage, pivot tables, and macros.
  • Relevant certifications in medical coding and billing (CCS, CPC, RHIA, RHIT, etc.).

Preferred Qualifications:

  • Experience in post-payment data mining auditing.
  • Background in concept and trend development.
  • Familiarity with payer auditing processes.

What We Offer:

  • Flexibility to work remotely from anywhere in the U.S.
  • A supportive and empowering work environment that encourages you to excel.
  • A dedicated team of colleagues and leadership committed to attracting and retaining top talent.
  • Comprehensive medical, dental, and vision benefits for employees and their families.
  • Competitive salary, equity options, 401(k) plan, and life insurance.
  • Generous reimbursement policy for learning and development opportunities.

The compensation for this role is determined by various factors unique to each candidate, including years of experience, skill set, and certifications.

Commitment to Diversity:

Machinify is devoted to hiring talented individuals from diverse backgrounds for all positions. We believe that embracing unique perspectives and cultures enriches our workplace.