Machinify
healthcare
DRGQAandTrainer
Neural analysis suggests this role is
optimal for Mid+ candidates.
“DRG QA and Trainer at Machinify. Skills: Quality Assurance, Training, DRG Methodologies, Coding, Clinical Validation. overseeing the quality assurance of DRG Reviewers. ensuring adherence to clinical, coding, and organizational standards”
What You'll Achieve.
ensure accuracy, compliance, and alignment with established coding and clinical validation guidelines; promote continuous improvement in audit accuracy, workflow efficiency, and reviewer performance; maximize financial outcomes; drive down healthcare costs
Industry & Context.
answering questions and offering guidance on complex cases or procedures
Proven success in a remote working environment
What They're Looking For.
Must Have
Associate or bachelor’s degree in nursing, health information management, or a related field, RHIA - Registered Health Information Administrator, RHIT - Registered Health Information Technician, CCDS - Certified Clinical Documentation Specialist, CDIP - Clinical Documentation Improvement Practitioner, CCS - Certified Coding Specialist, 2+ years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity, 1+ year of experience in a training or mentoring capacity, Ability to provide clear, actionable feedback to team members, 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, 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, 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
Nice to Have
Familiarity with multiple encoder/grouper applications
What You'll Do.
overseeing the quality assurance of DRG Reviewers
ensuring adherence to clinical
and organizational standards
auditing the work of both new hires and current staff
conducting training to ensure team members are equipped with the knowledge and skills needed to succeed
provides detailed feedback
collaborates with the educator on training initiatives
fosters a culture of continuous learning and improvement
Review and audit the work of new and existing DRG Reviewers to ensure accuracy
and alignment with established coding and clinical validation guidelines
detailed feedback to DRG Reviewers
highlighting areas for improvement and recognizing high-performance results
promote continuous improvement in audit accuracy
and reviewer performance
conducting supplemental training sessions for new hires on DRG methodologies
and proprietary tools
Provide ongoing training to existing staff
focusing on policy updates
and performance enhancement
Contribute to the development of training materials and resources as needed
Maintain comprehensive documentation of audit findings
and training activities
Generate reports on the quality assurance results and the effectiveness of training sessions for review by management
How You'll Work.
Team & Collaboration
cross-functional coordination; collaborates with management; Collaborate with management to promote continuous improvement in audit accuracy, workflow efficiency, and reviewer performance; Assist the educator by conducting supplemental training sessions; Contribute to the development of training materials and resources as needed in collaboration with the educator; 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
Communication Scope
Excellent written and verbal communication; Provide clear, actionable feedback
Process & Methodology
organizational and time management skills
Full Job Description
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. 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 actively fosters 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 colla
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