DRG QA and Trainer
About the role
About Us
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 85 health plans, including many of the top 20, and representing more than 270 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.
Role Summary
The DRG QA/Trainer is responsible for overseeing the quality assurance of DRG Reviewers, ensuring adherence to clinical, coding, and organizational standards. This position plays a key role in auditing the work of both new hires and current staff while conducting training to ensure team members are equipped with the knowledge and skills needed to succeed. Additionally, the QA/Trainer provides detailed feedback, collaborates with the educator on training initiatives, and actively fosters a culture of continuous learning and improvement.
Essential Duties and Responsibilities
Quality Assurance
- Review and audit the work of new and existing DRG Reviewers to ensure accuracy, compliance, and alignment with established coding and clinical validation guidelines.
- Provide constructive, detailed feedback to DRG Reviewers, highlighting areas for improvement and recognizing high-performance results.
- Collaborate with management to promote continuous improvement in audit accuracy, workflow efficiency, and reviewer performance.
Training Support
- Assist the educator by conducting supplemental training sessions for new hires on DRG methodologies, clinical validation, and proprietary tools.
- Provide ongoing training to existing staff, focusing on policy updates, skill development, and performance enhancement.
- Contribute to the development of training materials and resources as needed in collaboration with the educator.