VP, DRG Validation

Yesterday

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

💵 $200k - $230k / year

⏰ Full Time

🔴 Lead

👔 Vice President

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Machinify, Inc.

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Artificial Intelligence • Healthcare Insurance • Fintech

Machinify, Inc. is a company specializing in artificial intelligence solutions for the healthcare industry, particularly in optimizing payment processes and enhancing payment integrity. Their product suite, including Machinify Audit and Machinify Pay, is designed to automate and improve the accuracy of medical claims review, identifying billing and coding errors, and reducing administrative costs. Machinify's AI-driven platform covers millions of healthcare members and delivers significant financial benefits by efficiently processing medical claims and empowering health plans to tailor their policies. With a focus on transparency, control, and safety in AI, Machinify offers customized solutions that adapt to the specific needs of healthcare providers and contribute to the transformation of healthcare payments.

51 - 200 employees

🤖 Artificial Intelligence

⚕️ Healthcare Insurance

💳 Fintech

💰 $10M Series A on 2018-10

📋 Description

• Develop and execute a multi-platform production strategy for DRG validation services. • Align organizational goals with evolving regulatory requirements, payer expectations, and client needs. • Lead cross-functional teams to optimize workflows, automation, and platform interoperability. • Manage end-to-end production processes across multiple technology platforms, ensuring scalability and efficiency. • Manage daily workflow, resource allocation, productivity targets, and SLA adherence across multiple platforms. • Coordinate queue management, scheduling, capacity planning, and escalations to ensure smooth, timely execution. • Establish and monitor KPIs for productivity, accuracy, turnaround time, and client satisfaction. • Supervise a multidisciplinary team of clinical auditors, coders, and team leads, providing coaching, mentorship, and development plans. • Ensure adherence to CMS guidelines, ICD-10-CM/PCS coding standards, and payer-specific policies. • Serve as a senior point of contact for internal and external clients, providing strategic insights and operational transparency.

🎯 Requirements

• Bachelor’s degree in Nursing, Health Information Management, or related field required; Master’s preferred. • Active RN license required. • CCDS, CDIP, CCS, RHIA, or RHIT strongly preferred. • 5+ years of experience in clinical coding, DRG validation, or health information management. • 5+ years in executive leadership roles with multi-platform or multi-site operational oversight. • Deep understanding of DRG methodologies, coding guidelines, and healthcare reimbursement, focused on recovery strategy. • Proven success managing clinical teams and implementing scalable solutions in a remote work environment. • Experience with technology platforms used in clinical coding and validation (e.g., 3M, Optum, proprietary systems). • Strong analytical, communication, and strategic planning skills.

🏖️ Benefits

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