Medical Director, DRG Audit & AI Innovation - Remote

Overview

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 60 health plans, including many of the top 20, and representing more than 160 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.

In Short

• Seeking a board-certified physician for the role of Medical Director, DRG Audit & AI Innovation.
• Perform high-quality DRG clinical reviews ensuring coding accuracy.
• Work with product and engineering teams to refine AI learning.
• Conduct DRG reviews validating diagnoses, procedures, and coding.
• Translate medical judgment into structured feedback for AI.
• Serve as a subject matter expert for coding teams and nurses.
• Participate in quality improvement initiatives.
• MD/DO required with active license and board certification.
• 3+ years of experience in DRG audits or clinical validation.
• Work from anywhere in the US in a flexible environment.

Requirements

• MD/DO with active, unrestricted license.
• Board certification in Internal Medicine, Surgery, Family Medicine, or related specialty.
• 3+ years of experience in DRG audits or clinical validation reviews.
• Familiarity with ICD-10-CM/PCS and CMS DRG policies.
• Experience with AI-powered audit platforms preferred.
• Strong written communication skills.
• Ability to work in cross-functional teams.

Benefits

• Work from anywhere in the US.
• Full Medical/Dental/Vision for employees & their families.
• Flexible and trusting environment.
• Unlimited PTO.
• Competitive compensation package and 401(k) sponsorship.