DRG QA and Trainer

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. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. 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 QA/Trainer is responsible for overseeing the quality assurance of DRG Reviewers, ensuring adherence to clinical, coding, and organizational standards. This position plays a key role in auditing the work of both new hires and current staff while conducting training to ensure team members are equipped with the knowledge and skills needed to succeed. Additionally, the QA/Trainer provides detailed feedback, collaborates with the educator on training initiatives, and actively fosters a culture of continuous learning and improvement.

Essential Duties and Responsibilities

Quality Assurance:

• Review and audit the work of new and existing DRG Reviewers to ensure accuracy, compliance, and alignment with established coding and clinical validation guidelines.
• Provide constructive, detailed feedback to DRG Reviewers, highlighting areas for improvement and recognizing high-performance results
• Collaborate with management to promote continuous improvement in audit accuracy, workflow efficiency, and reviewer performance

Training Support:

• Assist the educator by conducting supplemental training sessions for new hires on DRG methodologies, clinical validation, and proprietary tools
• Provide ongoing training to existing staff, focusing on policy updates, skill development, and performance enhancement
• Contribute to the development of training materials and resources as needed in collaboration with the educator

Documentation & Reporting:

• Maintain comprehensive documentation of audit findings, feedback sessions, and training activities
• Generate reports on the quality assurance results and the effectiveness of training sessions for review by management

Collaboration & Support:

• Work closely with team leaders and the educator to ensure the training and QA processes align with the company’s standards and objectives
• Serve as an expert resource for DRG Reviewers and other staff members, answering questions and offering guidance on complex cases or procedures

Job Requirements

Education (required):

• Associate or bachelor’s degree in nursing, health information management, or a related field
• Relevant work experience may be considered in lieu of formal education

Certifications (one or more required):

• RHIA - Registered Health Information Administrator
• RHIT - Registered Health Information Technician
• CCDS - Certified Clinical Documentation Specialist
• CDIP - Clinical Documentation Improvement Practitioner
• CCS - Certified Coding Specialist

Experience:

• 2+ years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity
• 1+ year of experience in a training or mentoring capacity

Skills:

• Ability to provide clear, actionable feedback to team members
• Strong organizational and time management skills
• Excellent written and verbal communication
• High standards for quality and attention to detail
• Demonstrated ability to work independently and in teams
• Strong knowledge of DRG methodologies (MS & APR), ICD-10-CM/PCS coding, and UHDDS definitions
• Expertise in clinical criteria documentation and healthcare coding rules and regulations

Computer Equipment and Software:

• Experience working with multiple monitors
• Proven success in a remote working environment
• Proficient in Windows office systems, including the full Microsoft Suite and Teams
• Advanced skills in Microsoft Office (Excel, PowerPoint, Word)
• Experience with various software applications and collaboration with development teams
• Familiarity with multiple encoder/grouper applications

What We Offer:

• Work from anywhere in the US! Machinify is digital-first.

• Top Medical/Dental/Vision offerings

• FSA/HSA

• Tuition reimbursement

• Competitive salary, 401(k) with company match

• Additional health and wellness benefits and perks

• Flexible and trusting environment where you’ll feel empowered to do your best work

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.  We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range. 

Pay range: $100,000 - $120,000 + Bonus Potential

Equal Employment Opportunity at Machinify

We are committed to equal 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. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/