Training Specialist – Medical Review Audit, Clinical RN

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Machinify

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

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

Healthcare • Consulting • Logistics

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

• Design, build, and maintain comprehensive training curricula for clinical audit nurses and audit associates covering IPF and IRF claim review, documentation, medical necessity, coding, and payer policy • Develop onboarding, competency, performance-improvement, and program-implementation training, including job aids, reference materials, and assessments • Translate complex clinical, regulatory, and payer-specific requirements into clear audit-ready training content • Maintain training materials to reflect CMS rules, LCD/NCD policy, coding guidelines, and client-specific requirements • Build and manage training content in the LMS for effective remote delivery • Plan, coordinate, and deliver new-hire and ongoing education through 1:1, small-group, and virtual-classroom formats • Track training completion, assessment scores, audit accuracy, QA results, and appeals outcomes; use data to improve programs • Identify training gaps and execute targeted remediation plans • Conduct User Acceptance Testing on audit-platform workflows and reporting enhancements • Deliver training for client implementations, audit programs, and updated audit concepts • Serve as the primary IPF and IRF audit-training subject matter authority • Monitor CMS regulations, coverage criteria, coding guidelines, and clinical standards; update content and communicate changes • Provide input on audit-platform requirements, workflow design, and business rules • Partner with operations management, QA, and compliance to align training with business and client requirements • Support workflow documentation, process-improvement plans, and new-concept implementation • Provide input on training schedules to meet operational, legal, and contractual timelines

🎯 Requirements

• Active, unrestricted nursing license in good standing; not sanctioned or excluded from the Medicare program by OIG • AHIMA or AAPC coding certification required (CPC, CCS, CCS-P, RHIT, or equivalent) • Bachelor’s degree in Nursing, Health Information Management, Education, or a related field required • 3+ years of direct experience performing medical record audits in IPF and/or IRF claims in a payer or similar audit organization required • Direct clinical experience in an inpatient psychiatric or inpatient rehabilitation setting required • 3+ years of experience developing and delivering clinical or healthcare training programs with documented, measurable outcomes; remote learning delivery required • Demonstrated experience identifying training gaps from performance data and implementing remediation programs with evidence of improvement • Deep knowledge of IPF PPS, DSM-5 criteria, medical necessity standards, physician certification, treatment-plan and daily-progress-note standards, safety-assessment documentation, and ECT add-on billing • Strong knowledge of IRF PPS, the 60%/75% compliance rule, pre-admission screening, IRF-PAI timelines, 3-hour therapy rule, interdisciplinary team conferences, FIM scoring context, and CMG assignment • Proficiency with ICD-10-CM/PCS coding, DRG and CMG assignment logic, instructional design, LMS platforms, data interpretation, Microsoft Office Suite, and adult-learning evaluation frameworks • Familiarity with MCG or InterQual utilization-management tools • Curriculum development or e-learning authoring tools preferred • Master’s degree in Nursing, Education, Health Informatics, or a related field preferred

🏖️ Benefits

• Equal employment opportunity • Employment at will • E-Verify participation as required by applicable law • Reasonable accommodation during the application or recruitment process