DRG QA and Trainer

The Rawlings Group; Roseville (CA); Remote; USD 100,000 - 110,000; Full time

Job summary

A leading healthcare intelligence company is seeking a DRG QA/Trainer to oversee quality assurance processes and conduct training for new hires. This fully remote position offers a salary range of $100,000 to $110,000 annually and includes benefits like health coverage and tuition reimbursement. Successful candidates will possess relevant qualifications and a strong background in inpatient claims auditing.

Benefits

PTO, paid holidays, and volunteer days

Health, vision, and dental coverage

401(k) with company match

Tuition reimbursement

Company-paid life insurance

Qualifications

• 2+ years in inpatient claims auditing or clinical documentation integrity.
• 1+ year in training or mentoring.
• Certifications such as RHIA, RHIT, CCDS, or CDIP required.

Responsibilities

• Oversee the quality assurance of DRG Reviewers.
• Conduct training sessions for new hires.
• Generate reports on QA results and training effectiveness.

Skills

Clear, actionable feedback

Strong organization and time management

Excellent written and verbal communication

Attention to detail

Knowledge of DRG methodologies

Education

Associate or bachelor’s degree in nursing or related field

Tools

Windows/Microsoft Office

Teams

Job description

Overview

Job Location: California Office - Roseville, CA. Remote Type: Fully Remote. Salary Range: $100,000.00 - $110,000.00 Salary/year.

Description: Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering value, transparency, and efficiency to health plan clients. Location: This role is full remote.

What is the Opportunity

The DRG QA/Trainer is responsible for overseeing the quality assurance of DRG Reviewers, ensuring adherence to clinical, coding, and organizational standards. This position audits the work of both new hires and current staff while conducting training to equip team members with the knowledge and skills needed to succeed. The QA/Trainer provides detailed feedback, collaborates with the educator on training initiatives, and fosters a culture of continuous learning and improvement.

Responsibilities

• Quality Assurance: Review and audit the work of new and existing DRG Reviewers to ensure accuracy, compliance, and alignment with 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

• Documentation & Reporting: Maintain comprehensive documentation of audit findings, feedback sessions, and training activities
• Generate reports on QA results and training effectiveness for management review

• Collaboration & Support: Work closely with team leaders and the educator to ensure QA and training align with company standards and objectives
• Serve as an expert resource for DRG Reviewers and staff, answering questions and guiding on complex cases

Qualifications

• Education (required): Associate or bachelor’s degree in nursing, health information management, or related field; relevant work experience may be considered in lieu of formal education

• Certifications (one or more required): RHIA, RHIT, CCDS, CDIP, CCS

• Experience: 2+ years in inpatient claims auditing, QA, or clinical documentation integrity; 1+ year in training or mentoring

• Skills: Clear, actionable feedback; strong organization and time management; excellent written and verbal communication; attention to detail; ability to work independently and in teams; knowledge of DRG methodologies (MS & APR), ICD-10-CM/PCS, UHDDS; expertise in clinical criteria documentation and coding rules

• Computer Equipment & Software: Experience with multiple monitors; successful remote work experience; proficient in Windows/Microsoft Office and Teams; familiarity with encoder/grouper applications

• Physical Demands: Ability to sit/stand for long periods, occasional stooping and reaching; may lift up to 25 pounds; normal vision and hearing; role not substantially exposed to adverse environments

• Pay range: $100,000 - $110,000 USD. This is an exempt position; salary determined by factors including skill set, experience, and location

What’s in it for you

• PTO, paid holidays, and volunteer days
• Health, vision, and dental coverage; 401(k) with company match; flexible spending accounts
• Tuition reimbursement
• Company-paid benefits including life insurance, short-term disability, and parental leave
• Remote and hybrid work options

Values

• Ask why
• Think big
• Be humble
• Optimize for customer impact
• Deliver results

Equal Opportunity

Machinify is an equal employment opportunity employer. We participate in E-Verify as required by law. If you require a reasonable accommodation to complete any part of the application, contact our People Operations team. See our Candidate Privacy Notice for details.