- Auditing claims for medically appropriate services in inpatient and outpatient settings using medical review guidelines.
- Documenting findings with reference to appropriate policies and rules.
- Generating letters articulating audit findings.
Machinify
3 open remote positions
Machinify is a healthcare intelligence company delivering value and efficiency to health plan clients across the US. Deployed by over 85 health plans representing over 270 million lives, the company uses an AI-powered platform and best-in-class expertise to reimagine healthcare cost reduction.
Benefits Overview 1 of 3 jobs
401(k)
(1)
Dental
(1)
Life Insurance
(1)
Medical
(1)
PTO
(1)
Parental Leave
(1)
Short-Term Disability
(1)
Tuition Reimbursement
(1)
Vision
(1)
Open Positions
- Lead a remote team of outpatient coding auditors to identify overpayment opportunities and deliver accurate audit outcomes.
- Oversee audit operations, ensuring consistency in APC/APG grouping, OPPS packaging, and outpatient coding policy application.
- Manage team performance, productivity, and quality while providing coaching and professional development.
- Perform Skilled Nursing Facility (SNF) medical claims audit reviews for Government and Commercial Payers.
- Document findings referencing medical review guidelines and support audit findings during the appeals process.
- Work collaboratively with the audit team to identify vulnerabilities and improve medical policies and workflows.