Machinify
DRG Reviewer
Remote - US
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About the role
- 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.
- Your expertise will be critical in ensuring that payment decisions are supported by accurate and complete documentation, ultimately contributing to the integrity and efficiency of the payment process.
Responsibilities
- Collaborate with team leaders to ensure thorough review of DRG denials.
- Perform other duties as assigned.
- In this role, you will meticulously document findings, provide detailed clinical, policy, and regulatory support and collaborate with relevant stakeholders to ensure compliance with payment standards.
Requirements
- License / Certification (at least one of the following is required)
- Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more, and/or Inpatient Clinical Documentation Integrity experience of 2 years or more.
- Proven ability to apply critical judgment in clinical and coding determinations.
- Expertise in DRG methodologies (e.g., MS & APR), ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA's Coding Clinic Guidelines.
- Ability to work independently and efficiently with minimal supervision.
- Strong focus on quality and attention to detail.
- Deep curiosity and analytical skills to understand root causes of events and behaviors.
- In-depth knowledge of clinical criteria and documentation requirements to support code assignments.
- Work from anywhere in the US! Machinify is digital-first.
- Top Medical/Dental/Vision offerings
- Tuition reimbursement
- Competitive salary, 401(k) with company match
Nice to have
- Experience with readmission and/or short-stay reviews, and/or familiarity with InterQual and/or MCG (Milliman) criteria, is a plus.
Compensation
- Competitive salary, 401(k) with company match
Benefits
- 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.
- Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
- Ensure compliance with HIPAA regulations for protected health information.
- Education Requirements:
- An associate or bachelor's degree is required (in nursing or in health information management is preferred).
- Work experience may be considered in lieu of formal education at leadership discretion.
- RHIA - Registered Health Information Administrator
- RHIT - Registered Health Information Technician
Company info
- What We Offer: - Work from anywhere in the US!
This listing is sourced directly from Machinify's careers page and normalized into a canonical job model.