Machinify

Machinify

DRG Reviewer (Onsite - Hendersonville, TN)

US · Staff+

Sponsorship not specified$90k-$110kDetected 2 days ago
ComplianceAuditingOperations ManagementIntellectual PropertyCustomer SupportHIPAAICD-10LeadershipCommunicationCollaborationTime ManagementMicrosoft Office

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odds of building a lasting career here

50Sponsors, lottery-bound
Cap-exempt (no lottery)0
Sponsors this role90
Entry-level history0
PERM / green-card track0
Lottery odds (Level II)66
Fits your clock70

Sponsors, but it's cap-subject — you still face the weighted lottery (~30% per draw at Level II). 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 position is an onsite audit position that requires the DRG Reviewer to live in the commutable vicinity of Nashville, TN and be able to go onsite daily to the facilities as scheduled.
  • Pay range: $90,000-$110,000 This is an exempt position.

Responsibilities

  • Collaboration: Collaborate with team leaders to ensure DRG denial is thoroughly reviewed.
  • Coding Knowledge: Maintains expert knowledge of ICD-10-CM/PCS coding conventions and rules, Official Coding Guidelines and American Hospital Association (AHA) Coding Clinic.
  • Quality and Time Management: Perform all audits in observance of organizational quality and timeliness standards set by the audit operations management team, meets productivity requirements
  • Collaborate with team leaders to ensure DRG denial is thoroughly reviewed.
  • Maintains expert knowledge of ICD-10-CM/PCS coding conventions and rules, Official Coding Guidelines and American Hospital Association (AHA) Coding Clinic.
  • Perform all audits in observance of organizational quality and timeliness standards set by the audit operations management team, meets productivity requirements
  • Demonstrated ability to gain support for ideas and lead others to accomplish objectives.

Requirements

  • Associate or bachelor's degree in nursing (active/unrestricted license)
  • Proficiency: Utilizes proprietary auditing systems and intellectual property with a high level of proficiency to make sound and consistent audit determinations and rationales
  • Utilizes proprietary auditing systems and intellectual property with a high level of proficiency to make sound and consistent audit determinations and rationales
  • The DRG Reviewer must be able to work independently with minimal supervision.
  • Strong customer service skills are required.
  • National certification as Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), and/or Certified Coding Specialist (CCS).
  • Associate or bachelor's degree in health information management
  • RHIA - Registered Health Information Administrator
  • RHIT- Registered Health Information Technician
  • CCDS - Certified Clinical Documentation Specialist
  • CDIP - Clinical Documentation Improvement Practitioner

Skills

  • Other duties as assigned.
  • Participates in exit interviews with the client summarizing audit findings, which can vary depending on client/ facility
  • Practice Standards: Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association.
  • Minimum of five years hospital inpatient coding for IPPS reimbursement and/or at least 2 years' experience performing DRG validation.
  • Previous auditing/ recovery experience preferred.
  • Excellent oral and written communication skills.
  • Comprehensive knowledge of the DRG structure and regulatory requirements
  • Education (required)
  • Associate or bachelor's degree in nursing (active/unrestricted license); or
  • Associate or bachelor's degree in health information management; or
  • Work experience may be considered in lieu of formal education at leadership discretion
  • Certification (at least one of the following is required)

Compensation

  • $90,000-$110,000
  • This is an exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee's geographic location.

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.
  • The DRG Reviewer examines medical records to validate accuracy of the UB and items billed for accurate DRG assignment along with appropriate customer payment policies applied to each case reviewed.
  • Claims Review: Responsible for auditing patient medical records using clinical and coding guideline knowledge along with payer requirements to ensure reimbursement accuracy.
  • Technically savvy: Ability to use multiple tools, provider systems, and different medical records systems to perform audits in a comprehensive and timely manner
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This listing is sourced directly from Machinify's careers page and normalized into a canonical job model.