About this role
Role Overview
- Develop and execute strategic plans to grow the DRG CV program
- Collaborate with a multi-disciplinary team of programmers, operations staff, product leaders, and auditors
- Monitor emerging trends in payment integrity, audit methodologies, and health policy
- Lead the DRG Clinical Validation team
- Support internal and external team members by leading calls and presenting cases
- Oversee the entire process of clinical claims review
- Manage scheduling, reporting to management, and execution of plans
- Overall management of daily queue inventory
- Monitor individual and team results
- Establish and maintain quality assurance standards
- Demonstrate analytical skills to identify problems and trends
- Develop departmental policies, processes, and training standards
- Provide internal and external partners with evidence supporting industry standards and guidelines
- Manage and track data on key performance indicators
Requirements
- Bachelor’s degree (health administration, business, nursing)
- Equivalent experience of 5+ years in healthcare billing and coding
- Equivalent experience of 3+ years in claims auditing and recovery auditing
- Nursing license required
- Required certifications of CCDS or CDIP
- Previous supervisory experience required
Benefits
- 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
- Unlimited PTO
- Additional health and wellness benefits and perks
- Flexible and trusting environment where you’ll feel empowered to do your best work