Machinify

Auditor

• Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
• Document all findings referencing the appropriate policies and rules.
• Generate letters articulating audit findings.
• Supporting your findings during the appeals process if requested.
• Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.
• Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.
• Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.
• Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members.
• Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.
• Interface with and support the Medical Director and cross train in all clinical departments/areas.
• Other duties as required to meet business needs.

Medical Review Nurse – CMS/RAC Auditor, Government Audits

Administration

• Review incoming claims, assign statuses, organize data, and route files to auditors.
• Collaborate with teams to manage the import queue, reconcile balances, validate charges, correct errors, and route files.
• Oversee file intake and output, addressing inquiries, discrepancies, and errors.
• Analyze data trends and communicate updates on claims routing, efficiency, inventory, and volume.
• Monitor file-sharing processes, ensure data transfer accuracy, and maintain appropriate volume levels.
• Perform data entry and support additional administrative tasks as needed.

Claims Administrator

Operations

• Oversees and reviews audit determinations to ensure consistency in APC/APG grouping decisions, OPPS packaging interpretation, and outpatient coding policy application.
• Uses data, reports, and experience to proactively identify potential backlogs and align resources to meet business needs and SLAs.
• Effectively contributes to the development of medical review guidelines, coding education materials, and outpatient-specific training content.
• Supports audit management and subject matter experts with new concept implementation and ongoing maintenance of outpatient medical review guidelines, including annual OPPS updates and CMS rule changes.
• Accountable for achieving established productivity, quality, turnaround time, and employee engagement goals for the assigned team.
• Ensures audit activities are performed in accordance with applicable regulatory requirements, client contracts, organizational policies, and industry standards.
• Identifies process inefficiencies and implements solutions to improve accuracy, consistency, and productivity.
• Monitors audit quality performance and collaborates with Quality Assurance and leadership teams to ensure consistency, accuracy, and defensibility of audit findings.

Supervisor, Outpatient Audit Operations

QA Engineer

• Provide support to the departmental quality assurance program
• Perform quality reviews work assignment tasks related to specific departmental workflows
• Use available tools to gather data and analyze trends or patterns affecting quality; highlight key successes and share best practices with staff
• Identify areas of improvements and collaborate with departmental leadership team members to streamline processes
• Provide structured and timely recommendations through verbal and/or written feedback to leadership team
• Provide direct individual coaching/feedback to team members using specific examples highlighting performance strengths as well as areas of improvement needed
• Develop and conduct targeted group coaching sessions that address quality deficiencies and/or improvement opportunities
• Assist with creation of training materials and related duties as assigned
• Assess new hires after training to determine readiness for moving into support
• Observe and comply with all company and mandated rules, regulations, and protocols
• Select a quality sample for assigned staff members; conduct timely QA reviews
• Run QA reports summarizing results of QA conducted by staff members, team and department
• Follow Quality standard operating procedures
• Perform other duties as assigned

Healthcare Quality Assurance Specialist – SCA

• Supervise daily activities of QA specialists across multiple operational areas
• Ensure consistent execution of QA audits, scorecards, and monitoring processes
• Review completed audits for accuracy and consistency
• Conduct calibration sessions to ensure scoring alignment
• Provide coaching, feedback, and performance management
• Monitor QA productivity and turnaround times
• Identify trends and support corrective actions
• Ensure compliance with HIPAA, CMS, and internal policies
• Escalation management and issue resolution
• Support for training initiatives and documentation maintenance
• KPI monitoring and operational reporting support
• Partnership with operational leadership teams across departments

Operations Quality Supervisor

Software Engineer

• Lead and grow the AI/ML Engineering team, while coordinating execution across contributors including data scientists on collaborative projects.
• Design, deliver and operate the core AI/ML platform: agent frameworks, evaluation harnesses, labeling systems, document processing systems, semantic search, knowledge bases, model hosting, and more.
• Run AI/ML systems at scale in production with reliability, observability, performance, and incident response. Build a culture of operational excellence.
• Create processes to ensure proof-of-concept code from Data Science can be designed as production-grade services.
• Partner with the Chief AI Officer and Product Manager to build forward-looking product strategy. Drive structured thinking in ambiguity.
• Run tight, streamlined stand-ups across engineering and data science. Do capacity planning for driving predictability and velocity around delivery.
• Provide leadership in ensuring the cross-functional team can utilize AI technologies to accelerate team excellence in coding, PR reviews, testing, observability and incident response. Keep up with the latest developments in LLM/agent advances and modern AI/ML infrastructure.

Medical Review Nurse – CMS/RAC Auditor, Government Audits

Claims Administrator

Supervisor, Outpatient Audit Operations

Healthcare Quality Assurance Specialist – SCA

Operations Quality Supervisor

Senior Director, Engineering – ML