Remote DRG Manager - Healthcare Claims & Audit Lead

Machinify; Northern (KY); Hybrid; USD 125,000 - 140,000; Full time

Benefits offered by this job

Work from anywhere in the US

Medical/dental/vision insurance

401(k) with company match

Unlimited PTO

Wellness benefits

Job summary

Machinify is seeking a DRG Manager to lead clinical solutions development and validation. You will oversee inventory and team performance, guide audits, and support client needs with strategic oversight.

This role requires deep knowledge of Medicare and commercial DRG rules, with the ability to drive improvements across processes and systems. You will collaborate with a multi-disciplinary team to enhance readmissions, place of service, and other DRG-related workflows, while ensuring timely

Qualifications

• Bachelor’s degree in health administration, business, or nursing.
• 5+ years in healthcare billing and coding.
• 3+ years in claims auditing and recovery auditing.
• Experience sharing DRG audit process knowledge with sales, marketing, and development teams.
• Expertise in APR-DRG validation and Medicare/Commercial coding rules.

Responsibilities

• Enhance and review clinical solutions including readmissions and place of service.
• Lead DRG team, provide guidance, and develop staff growth plans.
• Oversee claims review processes and client configurations.
• Monitor regulatory updates and adjust written rules accordingly.
• Coordinate scheduling, reporting, and issue resolution.
• Develop policies, processes, and training standards.
• Provide evidence supporting industry auditing guidelines and standards.
• Deliver regular performance reports and drive optimization initiatives.
• Design deployment plans for programs that correct aberrant claims.

Skills

DRG validation

Leadership

Data analytics

Healthcare billing

Team management

Project management

Education

Bachelor’s degree in health administration, business, or nursing

Job description

Machinify is seeking a DRG Manager to lead clinical solutions development and validation. You will oversee inventory and team performance, guide audits, and support client needs with strategic oversight.

This role requires deep knowledge of Medicare and commercial DRG rules, with the ability to drive improvements across processes and systems. You will collaborate with a multi-disciplinary team to enhance readmissions, place of service, and other DRG-related workflows, while ensuring timely