DRG QA and Trainer

Machinify

6d•$100,000 - $120,000•Remote

About The Position

The DRG QA/Trainer oversees quality assurance for DRG Reviewers, ensuring their work adheres to clinical, coding, and organizational standards. The role audits work from new hires and current staff, provides detailed feedback, and conducts training to equip team members with the knowledge and skills needed to succeed. It also collaborates with the educator on training initiatives and promotes continuous learning and improvement. Responsibilities include reviewing and auditing DRG Reviewer work for accuracy, compliance, and alignment with coding and clinical validation guidelines; supporting supplemental and ongoing training; contributing to training materials; documenting audit findings, feedback, and training activities; and reporting on QA results and training effectiveness. The position also serves as an expert resource for reviewers and other staff on complex cases and procedures.

Requirements

Associate or bachelor’s degree in nursing, health information management, or a related field; relevant work experience may be considered in lieu of formal education.
At least one of the following certifications: RHIA, RHIT, CCDS, CDIP, or CCS.
At least 2 years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity.
At least 1 year of experience in a training or mentoring capacity.
Ability to provide clear, actionable feedback to team members.
Strong organizational and time-management skills.
Excellent written and verbal communication skills.
High standards for quality and attention to detail.
Ability to work independently and in teams.
Strong knowledge of MS and APR DRG methodologies, ICD-10-CM/PCS coding, and UHDDS definitions.
Expertise in clinical criteria documentation and healthcare coding rules and regulations.
Experience working with multiple monitors and proven success in a remote work environment.
Proficiency with Windows office systems, including Microsoft Suite and Teams; advanced skills in Excel, PowerPoint, and Word.
Experience with various software applications and collaboration with development teams.
Familiarity with multiple encoder/grouper applications.

Responsibilities

Review and audit the work of new and existing DRG Reviewers for accuracy, compliance, and alignment with established coding and clinical validation guidelines.
Provide constructive, detailed feedback, noting improvement opportunities and recognizing high performance.
Collaborate with management to improve audit accuracy, workflow efficiency, and reviewer performance.
Assist the educator with supplemental training for new hires on DRG methodologies, clinical validation, and proprietary tools.
Provide ongoing training to existing staff on policy updates, skill development, and performance improvement.
Contribute to training materials and resources in collaboration with the educator.
Maintain documentation of audit findings, feedback sessions, and training activities.
Generate reports on QA results and training effectiveness for management.
Work with team leaders and the educator to align training and QA processes with company standards and objectives.
Answer questions and provide guidance to DRG Reviewers and other staff on complex cases and procedures.