DRG QA/Training Manager

The role

The DRG QA/Training Manager leads the quality assurance and training team for the DRG Clinical Validation function. This role manages the audit program for DRG Reviewers and directs onboarding and ongoing training.

What you will do

• Lead the DRG QA/Trainer team by setting goals and coordinating daily activities
• Provide guidance and development plans for QA/Trainer staff
• Own the QA audit program for new and existing DRG Reviewers
• Identify problems and trends in audit results and implement corrective action plans
• Partner to plan and deliver new-hire training on DRG methodologies and clinical validation
• Oversee ongoing training for existing staff
• Direct the development and maintenance of training materials
• Develop departmental QA policies, processes, and training standards
• Provide reports on key performance indicators
• Collaborate with operations, product, data analytics, and technology teams

Required qualifications

• A bachelor’s degree in nursing, health information management, or health administration
• 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
• 5+ years of experience in healthcare billing and coding
• 3+ years of inpatient claims auditing, quality assurance, or recovery auditing experience, and/or inpatient Clinical Documentation Integrity experience
• Previous supervisory experience
• Experience in production and team management
• Experience conducting training for clinical or coding staff

Nice to have

• An active, unrestricted nursing license

Benefits

• Top Medical/Dental/Vision offerings
• FSA/HSA
• Tuition reimbursement
• Competitive salary
• 401(k) with company match
• Additional health and wellness benefits and perks

About the company

Machinify is a healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. It uses an AI-powered platform to maximize financial outcomes and drive down healthcare costs.