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Posted May 12DRG QA and Trainer
at Machinify
United StatesRemote
Responsibilities
- Review and audit the work of new and existing DRG Reviewers to ensure accuracy, compliance, and alignment with established coding and clinical validation guidelines.
- Collaborate with management to promote continuous improvement in audit accuracy, workflow efficiency, and reviewer performance Training Support:
- 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
Requirements
- 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.
- Associate or bachelor’s degree in nursing, health information management, or a related field Relevant work
- Certifications (one or more required):
- CCDS - Certified Clinical Documentation Specialist
- experience in inpatient claims auditing, quality assurance, or clinical documentation integrity 1+ year of
- experience in a training or mentoring capacity Skills:
- Demonstrated ability to work independently and in teams
- Strong knowledge of DRG methodologies (MS & APR), ICD-10-CM/PCS coding, and UHDDS definitions
- Experience working with multiple monitors
- 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 What We Offer:
Experience
- CCS - Certified Coding Specialist Experience: 2+ years of
Benefits
- 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.
- Top Medical/Dental/Vision offerings FSA/HSA
- Tuition reimbursement
- Competitive salary, 401(k) with company match
- Additional health and wellness benefits and perks
Additional details
- 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.
- 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:
- Provide constructive, detailed feedback to DRG Reviewers, highlighting areas for improvement and recognizing high-performance results
- 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
- Work closely with team leaders and the educator to ensure the training and QA processes align with the company’s standards and objectives