Machinify

Machinify

DRG Manager

Remote - US · Senior

Sponsorship not specified$125k-$140kDetected 2 days ago
Data AnalysisAuditingResearchLeadershipCommunicationProblem Solving

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odds of building a lasting career here

57Sponsors, lottery-bound
Cap-exempt (no lottery)0
Sponsors this role90
Entry-level history0
PERM / green-card track0
Lottery odds (Level III)83
Fits your clock70

Sponsors, but it's cap-subject — you still face the weighted lottery (~45% per draw at Level III). Good if you win; have a cap-exempt backup on your list.

Lottery odds assume a STEM candidate.

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Employer immigration record

from this employer's Department of Labor filings

Files H-1B transfers

17 transfer filings in the last year, covering 17 workers. Median labor-condition decision: 7 days. An employer that already files transfers is one that can take over an existing H-1B.

Sourced from Department of Labor LCA, PERM and prevailing-wage disclosure data. Employer matching is by name, so figures may be split across an employer's legal entities. Absence of a filing means none appears in our copy of the data, not that none exists.

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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.
  • This role requires expertise in healthcare payment methodologies and audit and review criteria to target key claims for review and recovery.
  • Machinify is an employment at will employer.

Responsibilities

  • Team Leadership: Lead the DRG team by providing guidance, counsel, and development plans to ensure long-term retention and professional growth of DRG staff.
  • Operational Oversight: Manage scheduling, reporting to management, issue resolution, and execution of plans.
  • Analytical Problem-Solving: Demonstrate analytical skills to identify problems and trends, develop solutions, and implement action plans.
  • Policy and Process Development: Develop departmental policies, processes, and training standards.
  • Support and Evidence: Provide internal and external partners with evidence and references supporting industry standards, auditing guidelines, and review stances.
  • Solution Development: Collaborate with a multi-disciplinary team to suggest solution development, including operations, product, data analytics, and technology.
  • Program Deployment: Design and deploy effective programs/solutions to identify and correct claims with aberrant results, providing feedback to resolve root causes.
  • Other Duties: Perform other duties as assigned.

Requirements

  • Experience with Readmission reviews
  • We participate in E-Verify as required by applicable law.

Skills

  • Claims Review Management:
  • Oversee the entire process of clinical claims review, understanding various client configurations and workflows.
  • Operational Oversight:
  • Work Coordination:
  • Performance Monitoring:
  • Analytical Problem-Solving:
  • Policy and Process Development:
  • Develop departmental policies, processes, and training standards.
  • Support and Evidence:
  • Performance Reporting:
  • Solution Development:
  • Timeline Management:

Compensation

  • $125,000-$140,000 USD, plus annual bonus.
  • In accordance with applicable state laws, we do not inquire about salary history during the recruitment process.
  • Competitive salary, 401(k) with company match
  • The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc.

Benefits

  • Top Medical/Dental/Vision offerings
  • Tuition reimbursement
  • Additional health and wellness benefits and perks
  • Flexible and trusting environment where you'll feel empowered to do your best work
  • Salary is one component of the total compensation package, which includes meaningful equity, excellent healthcare, flexible time off, and other benefits and perks.

Company info

  • As part of the Complex Payment Solutions Team, you will, as the DRG Manager, be responsible for the development and management of our clinical solutions, including MS and APR-DRG validation.
  • We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range.
  • We are proud to be an equal opportunity workplace.

Equal opportunity

  • If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know.

Visa & Work Authorization

  • al employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status
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This listing is sourced directly from Machinify's careers page and normalized into a canonical job model.