Supervisor, Medical Review Audit (Clinical)

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.

The Medical Review Audit Supervisor is a working supervisor who leads a remote team of clinical auditors performing medical record review, with primary oversight of Skilled Nursing Facility (SNF) audits. This role requires a licensed nurse with SNF clinical and/or reimbursement experience, command of Medicare Part A SNF coverage rules, the Patient Driven Payment Model (PDPM), and MDS 3.0 documentation, and the leadership presence to drive performance, hold the team accountable, and develop staff.

Key Responsibilities

Team Leadership & Performance Management

• Directly supervise a team of clinical auditors and audit associates; set clear productivity and quality expectations and hold the team to them consistently.
• Conduct regular performance reviews, coaching conversations, and constructive feedback sessions; escalate performance concerns through appropriate Leader and/or HR channels.
• Lead regular team meetings to align priorities, communicate updates, and maintain engagement in a remote environment.
• Monitor and manage time, attendance, and scheduling in accordance with company policy.
• Identify training gaps and coordinate targeted development, including calibration on PDPM classification, skilled need, and level of care determinations; support onboarding of new audit staff.

SNF Audit Oversight & Quality

• Serve as the primary subject matter authority for SNF audit programs; maintain current, working knowledge of Medicare Benefit Policy Manual Chapter 8 coverage requirements, PDPM, the MDS 3.0 RAI Manual, SNF consolidated billing, and Medicare Advantage and commercial SNF reimbursement policy.
• Maintain personal audit proficiency by performing a limited volume of SNF claim reviews; serve as technical resource and escalation point for complex or disputed cases, including skilled need, level of care, and PDPM component disputes.
• Oversee audit determinations on qualifying hospital stays, physician certification and recertification, daily skilled services, and MDS coding accuracy to ensure findings are consistent, defensible, and grounded in the medical record.
• Collaborate with the QA team to translate audit findings and error trends into clear, actionable feedback for auditors, driving continuous improvement in audit accuracy.
• Monitor team inventory and workflow to proactively identify and address backlogs before they i

[…]
atient care experience, including skilled nursing or post-acute care.

• 2+ years performing medical record audits, MDS review, or clinical reimbursement review in a payer, provider, or SNF setting, with direct experience in SNF Part A claims.
• 3+ years of supervisory or team leadership experience in a comparable production environment, or demonstrated readiness for people leadership through activities such as training, mentorship, subject matter expert, or equivalent; experience managing or supporting remote staff strongly preferred

Preferred Qualifications

• Resident Assessment Coordinator Certified (RAC-CT or RAC-CTA) through AAPACN.
• Medical coding certification (CPC, CCS, or equivalent).
• Prior experience as an MDS Coordinator, Director of Nursing, or Director of Clinical Reimbursement in a SNF.
• Experience with Medicare Advantage SNF prior authorization or concurrent review.
• Familiarity with SNF appeals workflows, including MAC redeterminations, and payer-provider dispute resolution processes.
• 5+ years of healthcare claims, coding, or clinical reimbursement experience with demonstrated expertise in ICD-10, PDPM, and MDS coding; SNF billing or MDS coordination experience required.

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/