DRG QA and Trainer

Who We Are
 

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 60 health plans, including many of the top 20, and representing more than 160 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.
 

Location:  This role is full remote
 

About the Opportunity
 

The DRG QA/Trainer is responsible for overseeing the quality assurance of DRG Reviewers, ensuring adherence to clinical, coding, and organizational standards. This position plays a key role in auditing the work of both new hires and current staff while conducting training to ensure team members are equipped with the knowledge and skills needed to succeed. Additionally, the QA/Trainer provides detailed feedback, collaborates with the educator on training initiatives, and plays an active role in fostering a culture of continuous learning and improvement.

Essential Duties and Responsibilities

Quality Assurance:

• Review and audit the work of new and existing DRG Reviewers to ensure accuracy, compliance, and alignment with established coding and clinical validation guidelines.
• Provide constructive, detailed feedback to DRG Reviewers, highlighting areas for improvement and recognizing high-performance results
• Collaborate with management to promote continuous improvement in audit accuracy, workflow efficiency, and reviewer performance

Training Support:

• Assist the educator by conducting supplemental training sessions for new hires on DRG methodologies, clinical validation, and proprietary tools
• Provide ongoing training to existing staff, focusing on policy updates, skill development, and performance enhancement
• Contribute to the development of training materials and resources as needed in collaboration with the educator

Documentation & Reporting:

• Maintain comprehensive documentation of audit findings, feedback sessions, and training activities
• Generate reports on the quality assurance results and the effectiveness of training sessions for review by management

Collaboration & Support:

• Work closely with team leaders and the educator to ensure the training and QA processes align with the company’s standards and objectives
• Serve as an expert resource for DRG Reviewers and other staff members, answering questions and offering guidance on complex cases or procedures

Education (required):

• Associate or bachelor’s degree in nursing, health information management, or a related field
• Relevant work experience may be considered in lieu of formal education

Certifications (one or more required):
 

• RHIA - Registered Health Information Administrator
• RHIT - Registered Health Information Technician
• CCDS - Certified Clinical Documentation Specialist
• CDIP - Clinical Documentation Improvement Practitioner
• CCS - Certified Coding Specialist

Experience:
 

• 2+ years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity
• 1+ year of experience in a training or mentoring capacity

Skills:
 

• Ability to provide clear, actionable feedback to team members
• Strong organizational and time management skills
• Excellent written and verbal communication
• High standards for quality and attention to detail
• Demonstrated ability to work independently and in teams
• Strong knowledge of DRG methodologies (MS & APR), ICD-10-CM/PCS coding, and UHDDS definitions
• Expertise in clinical criteria documentation and healthcare coding rules and regulations

Computer Equipment and Software:
 

• Experience working with multiple monitors
• Proven success in a remote working environment
• Proficient in Windows office systems, including the full Microsoft Suite and Teams
• Advanced skills in Microsoft Office (Excel, PowerPoint, Word)
• Experience with various software applications and collaboration with development teams
• Familiarity with multiple encoder/grouper applications

Physical Demands:
 

• Ability to sit or stand for long periods, with occasional stooping and reaching
• May require lifting up to 25 pounds
• Requires a normal range of vision and hearing, with or without accommodations
• Position is not substantially exposed to adverse environmental conditions

Pay range: $100,000-$110,000 USD

• This is an exempt position.  The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.

What’s in it for you      
 

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options
  
   

What values we’ll share with you
 

• Ask why
• Think big
• Be humble
• Optimize for customer impact
• Deliver results

At Machinify, we’re reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

 

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative and accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we’re passionate about a future with better outcomes for all.

 

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please contact our People Operations team at Machinify_Careers@machinify.com. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

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