Machinify Benefits Overview

Provides legal counsel for pharmacy Coordination of Benefits operations, advising on federal and state laws, CMS guidance, contracts, compliance, risk mitigation, disputes, settlements, and litigation. The attorney reviews operational matters, trains pharmacy staff, supports client inquiries, coordinates with outside counsel, communicates regulatory developments, and collaborates with compliance, operations, and PBM teams. The role also includes negotiation with PBMs and employer benefit managers and participation in industry conferences.

Design, build, and operate production data pipelines using Python, Spark SQL, and Airflow. Canonicalize healthcare and customer data into trusted internal models, optimize distributed processing, enforce schemas, and implement quality checks and observability. Support customer onboarding, streaming pipelines, troubleshooting, on-call operations, and platform best practices while collaborating with product, analytics, engineering, data science, and customer teams.

Supervises remote clinical audit staff and manages audit quality, productivity, inventory, staffing, and service-level performance. Performs clinical audits and quality assurance reviews, resolves rebuttals, supports appeals, identifies cost-saving opportunities, and ensures adherence to medical review guidelines. Provides coaching, training, performance management, reporting, and operational support while collaborating with management, HR, clients, and other departments. Requires nursing licensure, extensive healthcare claims and coding expertise, medical record auditing experience, and supervisory leadership.