Machinify - Inpatient Claims Auditor
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Requirements
• An associate or bachelor’s degree in nursing (active/unrestricted license); or in health information management is required. • 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 • 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.
Responsibilities
• Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement. • Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers. • Collaborate with team leaders to ensure thorough review of DRG denials. • Conduct audits in alignment with organizational quality and timeliness standards. • Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters. • Recommend improvements to the audit system to enhance efficiency. • Ensure compliance with HIPAA regulations for protected health information. • Perform other duties as assigned.
Benefits
• Work from anywhere in the US! Machinify is digital-first. • Top Medical/Dental/Vision offerings • 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. Salary is one component of the total compensation package, which includes meaningful equity, excellent healthcare, flexible time off, and other benefits and perks. • 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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