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Machinify

DRG QA/Training Manager

Remote, United States

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Job details

Education: Bachelor’s degree
Posting language: English
Posted: Oct 30, 2026

Original job description

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.

About the Opportunity

The DRG QA/Training Manager leads the quality assurance and training team supporting Machinify’s DRG Clinical Validation function, including MS-DRG and APR-DRG validation. Reporting to the Sr. Director, DRG Operations, this role manages the DRG QA/Trainers, owns the audit program for new and existing DRG Reviewers, and directs onboarding and ongoing training so reviewers apply current clinical, coding, and organizational standards. The manager works with the DRG Clinical Educator, DRG Managers, and cross-functional partners to turn audit findings into training, process changes, and measurable quality improvement.

What you’ll do

Team Leadership:

Lead the DRG QA/Trainer team by setting goals, assigning and prioritizing audit and training work, and coordinating daily activities
Provide guidance, counsel, and development plans that support long-term retention and professional growth of QA/Trainer staff
Communicate priorities, updates, and expectations through regular one-on-one and team meetings
Monitor individual and team results to ensure audits and training are completed on time and in accordance with department standards

Quality Assurance:

Own the QA audit program for new and existing DRG Reviewers, ensuring accuracy, compliance, and alignment with established coding and clinical validation guidelines
Review QA/Trainer audit findings for consistency and calibrate the team on audit criteria and feedback
Ensure DRG Reviewers receive constructive, detailed feedback that highlights areas for improvement and recognizes high-performance results
Identify problems and trends in audit results, determine root causes, and implement corrective action plans
Collaborate with leadership to drive continuous improvement in audit accuracy, workflow efficiency, and reviewer performance

Training & Education:

Partner with the educator to plan and deliver new-hire training on DRG methodologies, clinical validation, and proprietary tools
Oversee ongoing training for existing staff, focusing on policy updates, skill development, and performance enhancement
Direct the development and maintenance of training materials and resources, using audit trends to target content where it is needed
Evaluate the effectiveness of training sessions and adjust content based on quality results

Policy, Documentation & Reporting:

Develop departmental QA policies, processes, and training standards
Maintain comprehensive documentation of audit findings, feedback sessions, and training activities
Provide reports on key performance indicators, including quality scores, audit outcomes, and training effectiveness, on a predetermined schedule
Set timelines, communicate progress, track delivery, and escalate roadblocks or dependencies

Collaboration & Support:

Work closely with DRG Managers and the DRG Clinical Educator to ensure training and QA processes align with the company’s standards and objectives
Serve as an expert resource for DRG Reviewers, QA/Trainers, and other staff members, answering questions and offering guidance on complex cases or procedures
Provide internal and external partners with evidence and references supporting industry standards, auditing guidelines, and review stances
Collaborate with operations, product, data analytics, and technology teams to recommend process and solution improvements based on QA findings
Assist with research, special projects, and ad hoc claim reviews as needed
Perform other duties as assigned

What experience you bring (Role Requirements)

Education Requirements:

A bachelor’s degree in nursing (active/unrestricted license), health information management, or health administration is required
An active, unrestricted nursing license is preferred
Work experience may be considered in lieu of formal education at leadership discretion

Certification (at least one of the following is required)

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

Qualifications:

Experience

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 required
Experience in production and team management
Experience conducting training for clinical or coding staff
Experience with readmission reviews
Proven experience sharing DRG audit process knowledge with sales, marketing, and development teams

Skills

Expert in DRG methodologies and classification systems, including MS-DRG, APR-DRG, and AP-DRG
Expertise in ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA’s Coding Clinic Guidelines
Expertise in DRG validation, with in-depth knowledge of clinical criteria and documentation requirements to support code assignments
Deep understanding of Medicare and Commercial coding rules, regulations, and prospective payment systems
Familiarity with Milliman and InterQual guidelines
Proven ability to apply critical judgment in clinical and coding determinations
Deep curiosity and analytical skills to understand root causes of events and behaviors
Strong experience in data use and insights, including independently structuring and executing complex analyses
Ability to provide clear, actionable feedback and coach staff to improved performance
High standards of quality and attention to detail
Strong organizational and time management skills
Excellent written and verbal communication
Ability to work independently with minimal supervision and collaboratively in teams

Computer Equipment and Software:

Experience working with multiple monitors
Proven success in a remote working environment
Proficient in Windows office systems, including the full Microsoft Suite and Teams
Advanced skills in Microsoft Office (Excel, PowerPoint, Word)
Experience with various software applications and collaboration with development teams

What We Offer:

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

• Additional health and wellness benefits and perks

Flexible and trusting environment where you’ll feel empowered to do your best work

The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc. We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range.

Pay range: $130,000-$150,000 + Annual Bonus

Equal Employment Opportunity at Machinify

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

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More about this job

Skills

Quality assurance
Onboarding
Team leadership
Prioritization
Regulatory compliance
Process improvement
Workflow
Documentation
Reporting
Collaboration
Auditing
Data analysis
Research
Health records management
Leadership
Sales
Analytical skills
Coach employees
Attention to detail
Time management
Communication skills
Work independently
Computer equipment
Microsoft Windows
Microsoft Teams
Microsoft Office
Microsoft Excel
Microsoft PowerPoint
Microsoft Word

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