DRG Strategy Lead for Claims Optimization
Machinify
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Descrizione del lavoro
Machinify, a leading healthcare intelligence company, seeks a DRG Manager to drive DRG validation, Readmissions, and Place of Service expertise across our Complex Payment Solutions Team. You will lead a multidisciplinary DRG team, guide audits, and align with sales, marketing, and product to deliver compliant, optimized clinical solutions.
The role requires strong leadership, analytical thinking, and deep knowledge of Medicare and Commercial coding rules, including MSDRG, APR‑DRG, and
Competenze
- Bachelor’s degree in a health-related field or equivalent experience.
- 5+ years in healthcare billing and coding.
- 3+ years in claims auditing and recovery auditing.
- Proven DRG audit process knowledge with cross-team collaboration.
- Strong understanding of MSDRG, APR DRG, AP DRG, and APCs/EAPGs.
Mansioni
- Lead DRG team with guidance, development plans, and retention strategies.
- Oversee DRG clinical solutions development, validation, and optimization.
- Monitor regulatory updates and adjust rules accordingly.
- Manage scheduling, reporting, and issue resolution for the team.
- Coordinate daily work, set goals, and provide regular status updates.
- Develop policies, processes and training standards for the department.
- Provide evidence supporting industry standards and auditing guidelines.
Conoscenze
Formazione
Descrizione del lavoro
Machinify, a leading healthcare intelligence company, seeks a DRG Manager to drive DRG validation, Readmissions, and Place of Service expertise across our Complex Payment Solutions Team. You will lead a multidisciplinary DRG team, guide audits, and align with sales, marketing, and product to deliver compliant, optimized clinical solutions.
The role requires strong leadership, analytical thinking, and deep knowledge of Medicare and Commercial coding rules, including MSDRG, APR‑DRG, and
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