DRG QA and Trainer

<div class="content-intro"><p><span style="color: rgb(0, 0, 0);">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.</span></p></div><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">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.</span></p> <h3><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Essential Duties and Responsibilities</span></h3> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>Quality Assurance:</strong></span></p> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Review and audit the work of new and existing DRG Reviewers to ensure accuracy, compliance, and alignment with established coding and clinical validation guidelines.</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Provide constructive, detailed feedback to DRG Reviewers, highlighting areas for improvement and recognizing high-performance results</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Collaborate with management to promote continuous improvement in audit accuracy, workflow efficiency, and reviewer performance</span></li> </ul> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>Training Support:</strong></span></p> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Assist the educator by conducting supplemental training sessions for new hires on DRG methodologies, clinical validation, and proprietary tools</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Provide ongoing training to existing staff, focusing on policy updates, skill development, and performance enhancement</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Contribute to the development of training materials and resources as needed in collaboration with the educator</span></li> </ul> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>Documentation &amp; Reporting:</strong></span></p> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Maintain comprehensive documentation of audit findings, feedback sessions, and training activities</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Generate reports on the quality assurance results and the effectiveness of training sessions for review by management</span></li> </ul> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>Collaboration &amp; Support:</strong></span></p> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Work closely with team leaders and the educator to ensure the training and QA processes align with the company’s standards and objectives</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Serve as an expert resource for DRG Reviewers and other staff members, answering questions and offering guidance on complex cases or procedures</span></li> </ul> <p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Job Requirements</span></strong></p> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>Education (required):</strong></span></p> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Associate or bachelor’s degree in nursing, health information management, or a related field</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Relevant work experience may be considered in lieu of formal education</span></li> </ul> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>Certifications (one or more required):</strong></span></p> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">RHIA - Registered Health Information Administrator</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">RHIT - Registered Health Information Technician</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">CCDS - Certified Clinical Documentation Specialist</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">CDIP - Clinical Documentation Improvement Practitioner</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">CCS - Certified Coding Specialist</span></li> </ul> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>Experience:</strong></span></p> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">2+ years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">1+ year of experience in a training or mentoring capacity</span></li> </ul> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>Skills:</strong></span></p> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Ability to provide clear, actionable feedback to team members</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Strong organizational and time management skills</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Excellent written and verbal communication</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">High standards for quality and attention to detail</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Demonstrated ability to work independently and in teams</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Strong knowledge of DRG methodologies (MS &amp; APR), ICD-10-CM/PCS coding, and UHDDS definitions</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Expertise in clinical criteria documentation and healthcare coding rules and regulations</span></li> </ul> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>Computer Equipment and Software:</strong></span></p> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Experience working with multiple monitors</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Proven success in a remote working environment</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Proficient in Windows office systems, including the full Microsoft Suite and Teams</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Advanced skills in Microsoft Office (Excel, PowerPoint, Word)</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Experience with various software applications and collaboration with development teams</span></li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);">Familiarity with multiple encoder/grouper applications</span></li> </ul> <p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; color: rgb(0, 0, 0);"><strong>What We Offer:</strong></span></p> <div>&nbsp;</div> <ul> <li style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;">Work from anywhere in the US! Machinify is digital-first.</span></li> <li style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;"> <div><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;">Top Medical/Dental/Vision offerings</span></div> </li> <li style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;"> <div><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;">FSA/HSA</span></div> </li> <li style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;"> <div><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;">Tuition reimbursement</span></div> </li> <li style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;"> <div><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;">Competitive salary, 401(k) with company match</span></div> </li> <li style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;"> <div><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;">Additional health and wellness benefits and perks</span></div> </li> <li style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;">Flexible and trusting environment where you’ll feel empowered to do your best work</span></li> </ul> <div><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;">The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc. &nbsp;We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range.&nbsp;</span></div> <div>&nbsp;</div> <div><span style="color: rgb(0, 0, 0); font-family: arial, helvetica, sans-serif; font-size: 12pt;">Pay range: $100,000-$120,000 + Quarterly Bonus</span></div><div class="content-conclusion"><div><span style="color: rgb(0, 0, 0);"><strong>Equal Employment Opportunity at Machinify</strong></span></div> <div>&nbsp;</div> <div><span style="color: rgb(0, 0, 0);">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 let our recruiters know. See our Candidate Privacy Notice at:&nbsp;<u><a id="m_4907613542122963413OWAae7934b9-fa06-3f98-e336-0c5f8a6d5638" style="color: rgb(0, 0, 0);" href="https://www.machinify.com/candidate-privacy-notice/" target="_blank" data-saferedirecturl="https://www.google.com/url?q=https://www.machinify.com/candidate-privacy-notice/&amp;source=gmail&amp;ust=1763168899816000&amp;usg=AOvVaw0FJrzi47RtxTK_RN63lbaj">https://www.machinify.com/candidate-privacy-notice/</a></u></span></div></div>