Remote Post-Acute Audit Policy Lead

Machinify; United States; Teletrabalho; USD 110 000 - 150 000; Tempo integral

Resumo da oferta

Machinify is seeking an Audit Policy Analyst for Post-Acute Services to lead development and maintenance of post-acute audit concepts across DME, home health, and home infusion claims. This role requires strong knowledge of PDGM, Medicare rules, and payer policies, with the ability to work remotely across the US.

You will QA audit concepts, validate logic against billing rules, and mentor a team of subject matter experts.

Qualificações

• Bachelor's degree or equivalent in a related field.
• RN license or certified coder credential required.
• 5+ years in post-acute claims auditing or payment integrity preferred.

Responsabilidades

• Develop and maintain post-acute audit concepts for DME, home health and home infusion claims.
• Validate audit concepts against coding rules, exemptions, and payer policies.
• Lead QA reviews and ensure timely updates in response to regulatory changes.
• Collaborate with operations, clinical teams, and technology to ensure policy effectiveness.
• Provide training materials and references for auditors and clinicians.

Conhecimentos

Post-acute coding knowledge

Data analysis

Communication

Remote collaboration

Formação académica

Bachelor's degree in nursing, health administration, business, or related field

RN or Certified Coder credential (RHIA/RHIT/AHIMA/AAPC)

Ferramentas

Windows Office (Excel, PowerPoint)

Home Health PDGM Grouper

Encoder and grouper applications

Descrição da oferta de emprego

Machinify is seeking an Audit Policy Analyst for Post-Acute Services to lead development and maintenance of post-acute audit concepts across DME, home health, and home infusion claims. This role requires strong knowledge of PDGM, Medicare rules, and payer policies, with the ability to work remotely across the US.

You will QA audit concepts, validate logic against billing rules, and mentor a team of subject matter experts.