DRG QA/Training Manager

The posting, as Machinify wrote it

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

About the Opportunity

The DRG QA/Training Manager leads the quality assurance and training team supporting Machinify’s DRG Clinical Validation function, including MS-DRG and APR-DRG validation. Reporting to the Sr. Director, DRG Operations, this role manages the DRG QA/Trainers, owns the audit program for new and existing DRG Reviewers, and directs onboarding and ongoing training so reviewers apply current clinical, coding, and organizational standards. The manager works with the DRG Clinical Educator, DRG Managers, and cross-functional partners to turn audit findings into training, process changes, and measurable quality improvement.

What you’ll do

Team Leadership

• Lead the DRG QA/Trainer team by setting goals, assigning and prioritizing audit and training work, and coordinating daily activities
• Provide guidance, counsel, and development plans that support long-term retention and professional growth of QA/Trainer staff
• Communicate priorities, updates, and expectations through regular one-on-one and team meetings
• Monitor individual and team results to ensure audits and training are completed on time and in accordance with department standards

Quality Assurance

• Own the QA audit program for new and existing DRG Reviewers, ensuring accuracy, compliance, and alignment with established coding and clinical validation guidelines
• Review QA/Trainer audit findings for consistency and calibrate the team on audit criteria and feedback
• Ensure DRG Reviewers receive constructive, detailed feedback that highlights areas for improvement and recognizes high-performance results
• Identify problems and trends in audit results, determine root causes, and implement corrective action plans
• Collaborate with leadership to drive continuous improvement in audit accuracy, workflow efficiency, and reviewer performance

Training & Education

• Partner with the educator to plan and deliver new-hire training on DRG methodologies, clinical validation, and proprietary tools
• Oversee ongoing training for existing staff, focusing on policy updates, skill development, and performance enhancement
• Direct the development and maintenance of training materials and resources, using audit trends to target content where it is needed
• Evaluate the effectiveness of training sessions and adjust content based on quality results

Policy, Documentation & R
[…]

• Strong organizational and time management skills
• Excellent written and verbal communication
• Ability to work independently with minimal supervision and collaboratively in teams

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

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

The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc. We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range.

Pay range: $130,000-$150,000 + Annual Bonus

Equal Employment Opportunity at Machinify

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/