Supervisor, Outpatient Audit Operations

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🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

⚙️ Operations

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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

• Oversees and reviews audit determinations to ensure consistency in APC/APG grouping decisions, OPPS packaging interpretation, and outpatient coding policy application. • Uses data, reports, and experience to proactively identify potential backlogs and align resources to meet business needs and SLAs. • Effectively contributes to the development of medical review guidelines, coding education materials, and outpatient-specific training content. • Supports audit management and subject matter experts with new concept implementation and ongoing maintenance of outpatient medical review guidelines, including annual OPPS updates and CMS rule changes. • Accountable for achieving established productivity, quality, turnaround time, and employee engagement goals for the assigned team. • Ensures audit activities are performed in accordance with applicable regulatory requirements, client contracts, organizational policies, and industry standards. • Identifies process inefficiencies and implements solutions to improve accuracy, consistency, and productivity. • Monitors audit quality performance and collaborates with Quality Assurance and leadership teams to ensure consistency, accuracy, and defensibility of audit findings.

🎯 Requirements

• One of the following active certifications: RHIA, RHIT, CCS, CPC, COC • 7+ years of facility outpatient coding experience in a hospital or health system setting, with demonstrated expertise in APC grouping and OPPS payment rules. • 2+ years of outpatient facility coding audit, performing pre-payment and post-payment reimbursement reviews, or payment integrity experience in a provider, payer, or audit vendor environment. • 3+ years of relevant management or leadership experience in a similar business environment (preferably experience overseeing remote coding audit staff). • Experience reviewing outpatient facility claims for coding accuracy and applying APG reimbursement guidelines during audit and overpayment identification activities. • Demonstrated success managing productivity, quality, turnaround time, and workforce performance metrics in a remote audit environment.

🏖️ Benefits

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