Machinify - Medical Review Nurse - Clinical Validation

• Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual. • Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding. • Knowledge of insurance programs program, particularly the coverage and payment rules. • Ability to maintain high quality work while meeting strict deadlines. • Excellent written and verbal communication skills. • Ability to manage multiple tasks including desk audits and claims review. • Must be able to independently use standard office computer technology (e.g. email SharePoint, slack, outlook calendar etc.) • Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload • Effectively work independently and as a team, in a remote setting. • An associate or bachelor’s degree in nursing (active/unrestricted RN license). • Certification (at least one of the following is required): • CCDS - Certified Clinical Documentation Specialist • CDIP - Clinical Documentation Improvement Practitioner • CCS - Certified Coding Specialist • CIC - Certified Inpatient Coder • Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required, and/or Inpatient Clinical Documentation Integrity experience of 2 years or more required. • Strong focus on quality and attention to detail. • Deep curiosity and analytical skills to understand root causes of events and behaviors. • Proven ability to apply critical judgment in clinical and coding determinations. • In-depth knowledge of clinical criteria and documentation requirements to support code assignments. • Expert in DRG methodologies (e.g., MS & APR). • Expertise in ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA’s Coding Clinic Guidelines. • Ability to work independently and efficiently with minimal supervision. • 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/