Senior DRG Audit Subject Matter Expert (SME) - Remote

Overview

Machinify is seeking a Senior DRG Audit Subject Matter Expert (SME) to drive quality testing of two of our products in the Audits and Utilization Management space, leveraging AI-powered software products to transform healthcare claims and payment operations.

In Short

• Conduct comprehensive DRG validation audits of inpatient medical records.
• Serve as an inpatient coding expert and resource for coding teams.
• Develop and refine coding policies and procedures.
• Monitor and audit inpatient and outpatient client accounts.
• Assist with edits, denials, and appeals.
• Help create various documents and reports.
• Support payment integrity and audit opportunities.
• Stay updated with the latest coding guidelines and regulations.
• Achieve expected accuracy and quality levels in audits.
• Identify new claim types and overpayment opportunities.

Requirements

• Education: Associates or Bachelor's degree in Nursing or Health Information Management.
• Coding Certifications: RHIA or RHIT required; CCS or CIC preferred.
• 5-10 years of experience with ICD-9/10CM, MS-DRG, and outpatient coding.
• Expertise in medical claims billing/payment systems.
• Excellent written and verbal communication skills.
• Proficiency in EMRs and encoders.

Benefits

• Flexible and trusting work environment.
• Work from anywhere in the US.
• Supportive colleagues and leadership.
• Comprehensive medical, vision, and dental benefits.
• Competitive salary and equity, 401(k) sponsorship.