About the job
Machinify Inc. stands at the forefront of healthcare intelligence, offering unparalleled expertise across the payment continuum. We provide significant value, transparency, and efficiency to our health plan clients nationwide. With deployment across over 85 health plans, including many in the top 20, and serving more than 270 million lives, we combine a fully configurable, AI-powered platform with exceptional industry expertise. Our mission is to continually redefine possibilities within our sector, creating straightforward, impactful solutions that enhance financial outcomes and reduce healthcare expenses.
About the Opportunity
As a DRG Dispute Reviewer, you will play a crucial role in assessing provider appeals and original audit findings to ensure accurate DRG assignments and payment outcomes. This position demands a thorough understanding of MS-DRG and APR-DRG methodologies, clinical validation, coding standards, and payer policies. Leveraging your clinical and coding expertise, you will independently evaluate documentation to affirm that audit decisions are precise, defensible, and compliant. This role is essential for supporting regulatory adherence, identifying and recovering overpayments, and fostering optimal documentation and reimbursement practices across various healthcare systems.

