About the job
Machinify Inc. is at the forefront of healthcare intelligence, specializing in optimizing payment processes to provide unparalleled value and efficiency to health plan clients nationwide. With a presence across more than 85 health plans, including many of the top 20, and serving over 270 million lives, we combine a highly configurable, AI-driven platform with industry-leading expertise. Our mission is to continuously innovate within the healthcare sector, devising straightforward and impactful solutions that enhance financial outcomes while reducing healthcare expenses.
About the Role
As a member of our Complex Payment Solutions Team, you will play a pivotal role as a DRG Reviewer. This position involves conducting comprehensive DRG payment validation assessments, including clinical and coding evaluations of medical records and associated documentation based on contract-specific criteria. A thorough understanding of clinical guidelines, coding standards, and regulatory frameworks is essential for making precise payment determinations.
In this capacity, you will meticulously document your findings, offer detailed clinical, policy, and regulatory advice, and collaborate with relevant stakeholders to uphold compliance with payment standards. Your expertise will be integral in ensuring payment decisions are backed by accurate and complete documentation, thereby enhancing the integrity and efficiency of the payment process.

