DRG Reviewer

Machinify

DRG Reviewer at Machinify conducting thorough DRG payment validation reviews including medical record assessments. Collaborating with stakeholders to ensure compliance and support accurate payment determinations.

Posted 6/29/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $90,000 - $115,000 per yearWebsite

About the role

Key responsibilities & impact

Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement.
Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers.
Collaborate with team leaders to ensure thorough review of DRG denials.
Conduct audits in alignment with organizational quality and timeliness standards.
Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters.
Recommend improvements to the audit system to enhance efficiency.
Ensure compliance with HIPAA regulations for protected health information.
Perform other duties as assigned.

Requirements

What you’ll need

An associate or bachelor’s degree in nursing (active/unrestricted license); or in health information management is required.
Work experience may be considered in lieu of formal education at leadership discretion.
RHIA - Registered Health Information Administrator
RHIT- Registered Health Information Technician
CCDS - Certified Clinical Documentation Specialist
CDIP - Clinical Documentation Improvement Practitioner
CCS - Certified Coding Specialist
CIC - Certified Inpatient Coder
Inpatient claims auditing, quality assurance or recovery auditing experience of 2 years or more required, and/or Inpatient Clinical Documentation Integrity experience of 2 years or more required
Strong focus on quality and attention to detail.
Deep curiosity and analytical skills to understand root causes of events and behaviors.
Proven ability to apply critical judgment in clinical and coding determinations.
In-depth knowledge of clinical criteria and documentation requirements to support code assignments.
Expert in DRG methodologies (e.g., MS & APR).
Expertise in ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA’s Coding Clinic Guidelines.
Ability to work independently and efficiently with minimal supervision.

Benefits

Comp & perks

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
PTO
Additional health and wellness benefits and perks
Flexible and trusting environment where you’ll feel empowered to do your best work

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Clinical AuditingCoding ComplianceQuality AssuranceDocumentation RequirementsCritical JudgmentAnalytical SkillsDRG MethodologiesICD-10-CM/PCS CodingProprietary Auditing SystemsEvidence-Based Rationale

Soft Skills

Attention to DetailCuriosityIndependent WorkCollaborationCommunication

Certifications

Registered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)Certified Clinical Documentation Specialist (CCDS)Certified Inpatient Coder (CIC)