DRG QA and Trainer

New

MachinifyHealthcare coding

Location: Remote - USFull-TimeJunior

Salary$100,000 - $120,000 + Bonus Potential

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Job Details

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
Required Skills: Microsoft ExcelQuality AssurancePowerPoint

Have an 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.
Hold one or more of the following certifications: RHIA, RHIT, CCDS, CDIP, or CCS.
Have 2+ years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity.
Have 1+ year of experience in a training or mentoring capacity.
Know DRG methodologies (MS & APR), ICD-10-CM/PCS coding, and UHDDS definitions.
Have expertise in clinical criteria documentation and healthcare coding rules and regulations.
Be able to provide clear, actionable feedback to team members.
Demonstrate strong organizational and time management skills, attention to detail, and the ability to work independently and in teams.
Have experience working with multiple monitors and success in a remote working environment.
Be proficient in Windows office systems, Microsoft Suite, and Teams, with advanced skills in Excel, PowerPoint, and Word.
Have experience with software applications and collaboration with development teams, and familiarity with multiple encoder/grouper applications.

Review and audit new and existing DRG Reviewers’ work for accuracy, compliance, and alignment with coding and clinical validation guidelines.
Provide DRG Reviewers with constructive, detailed feedback on improvement areas and high-performance results.
Collaborate with management to improve audit accuracy, workflow efficiency, and reviewer performance.
Conduct supplemental training for new hires on DRG methodologies, clinical validation, and proprietary tools.
Provide ongoing training to existing staff on policy updates, skill development, and performance enhancement.
Contribute to training materials and resources in collaboration with the educator.
Maintain documentation of audit findings, feedback sessions, and training activities.
Generate reports on quality assurance results and training effectiveness for management.
Work with team leaders and the educator to align training and QA processes with company standards and objectives.
Answer staff questions and provide guidance on complex cases or procedures.

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