DRG QA and Trainer

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

Essential Duties and Responsibilities

Quality Assurance:

• Review and audit the work of new and existing DRG Reviewers to ensure accuracy, compliance, and alignment with established 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 the quality assurance results and the effectiveness of training sessions for review by management

Collaboration & Support:

• Work closely with team leaders and the educator to ensure the training and QA processes align with the company’s standards and objectives
• Serve as an expert resource for DRG Reviewers and other staff members, answering questions and offering guidance on complex cases or procedures

Job Requirements

Education (required):

• Associate or bachelor’s degree in nursing, health information management, or a related field
• Relevant work experience may be considered in lieu of formal education

Certifications (one or more required):

• RHIA - Registered Health Information Administrator
• RHIT - Registered Health Information Technician
• CCDS - Certified Clinical Documentation Specialist
• CDIP - Clinical Documentation Improvement Practitioner
• CCS - Certified Coding Specialist

Experience:

• 2+ years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity
• 1+ year of experience in a training or mentoring capacity

Skills:

• Ability to provide clear, actionable feedback to team members
• Strong organizational and time management skills
• Excellent written and verbal communication
• High standards for quality and attention to detail
• Demonstrated ability to work independently and in teams
• Strong knowledge of DRG methodologies (MS & APR), ICD-10-CM/PCS coding, and UHDDS definitions
• Expertise in clinical criteria documentation and healthcare coding rules and regulations

Computer Equipment and Software:

• Experience working with multiple monitors
• Proven success in a remote working environment
• Proficient in Windows office systems, including the full Microsoft Suite and Teams
• Advanced skills in Microsoft Office (Excel, PowerPoint, Word)
• Experience with various software applications and collaboration with development teams
• Familiarity with multiple encoder/grouper applications

What We Offer:

• Work from anywhere in the US! Machinify is digital-first.
• Top Medical/Dental/Vision offerings
• FSA/HSA
• Tuition reimbursement
• Competitive salary, 401(k) with company match
• Additional health and wellness benefits and perks
• Flexible and trusting environment where you’ll feel empowered to do your best work