DRG QA Trainer

🕒 May 12

🇺🇸 United States – Remote

💵 $100k - $120k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

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Machinify

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

🤖 Artificial Intelligence

☁️ SaaS

💰 $10M Series A - Machinify on 2018-10

Healthcare Insurance • Artificial Intelligence • SaaS

Machinify is a healthcare-focused AI platform and services company that reshapes healthcare payments and payment integrity. Its AI operating system unifies claims, medical records, contracts, and policies, and uses foundation models and task-specific agents to automate and improve coding, payment accuracy, recoveries, and cost avoidance. Machinify serves health plans (including 18 of the top 20), supports insourced, hybrid, or fully-managed deployments, and emphasizes measurable outcomes — reporting 85+ customers, 270M member lives covered, and $6B+ in annual cost avoidance and recoveries.

📋 Description

• 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 • 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 • 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 • 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

🎯 Requirements

• 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 • 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

🏖️ Benefits

• Work from anywhere in the US! Machinify is digital-first. • Top Medical/Dental/Vision offerings • FSA/HSA • Tuition reimbursement • Competitive salary, 401(k) with company match • Additional health and wellness benefits and perks • Flexible and trusting environment where you’ll feel empowered to do your best work