Machinify · 1 month ago
DRG Reviewer
United States
Full-time
Hybrid
Entry, Mid Level
$85K/yr - $105K/yr
2+ years expMachinify is a leading healthcare intelligence company focused on delivering value and efficiency to health plans. The DRG Reviewer will conduct thorough DRG payment validation reviews, ensuring accurate payment determinations through clinical and coding assessments of medical records.
AnalyticsArtificial Intelligence (AI)Business IntelligenceMachine LearningPredictive AnalyticsSaaS
Responsibilities
Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement
Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers
Collaborate with team leaders to ensure thorough review of DRG denials
Conduct audits in alignment with organizational quality and timeliness standards
Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters
Recommend improvements to the audit system to enhance efficiency
Ensure compliance with HIPAA regulations for protected health information
Perform other duties as assigned
Qualification
Required
An associate or bachelor's degree in nursing (active/unrestricted license); or in health information management is required
Work experience may be considered in lieu of formal education at leadership discretion
At least one of the following certifications is 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, CIC - Certified Inpatient Coder
Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required, and/or Inpatient Clinical Documentation Integrity experience of 2 years or more required
Strong focus on quality and attention to detail
Deep curiosity and analytical skills to understand root causes of events and behaviors
Proven ability to apply critical judgment in clinical and coding determinations
In-depth knowledge of clinical criteria and documentation requirements to support code assignments
Expert in DRG methodologies (e.g., MS & APR)
Expertise in 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
Benefits
PTO, Paid Holidays, and Volunteer Days
Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
Tuition Reimbursement
Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
Remote and hybrid work options
Company
Machinify
Machinify is a SaaS platform that enables non-technical enterprises to build AI-powered products and processes.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$12.79MKey Investors
Battery Ventures
2025-01-10Acquired
2018-10-08Series A· $10M
2016-03-15Seed· $2.79M
Leadership Team
Edward Lichty
Strategic Operations
Prasanna Ganesan
EVP & Chief Product Officer
Recent News
2025-12-19
Dallas Morning News
2025-10-24
globallegalchronicle.com
2025-10-24
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