Medical Director, DRG Audit & AI Innovation

Machinify

84d

About The Position

We are seeking a board-certified physician with strong inpatient coding and DRG audit expertise to join our team as Medical Director, DRG Audit & AI Innovation. This position combines the rigor of traditional DRG medical director responsibilities with the opportunity to directly shape the future of AI-powered clinical auditing. Your primary responsibility will be to perform high-quality DRG clinical reviews, ensuring diagnostic and coding accuracy for hospital claims. In parallel, you will work with our product and engineering teams to refine how our AI agent learns from medical director decision-making. By blending expert review with feedback into the AI system, you will help transform traditional audits into seamless, AI-powered adjudication that can scale across the healthcare landscape.

Requirements

• MD/DO with active, unrestricted license.
• Board certification in Internal Medicine, Surgery, Family Medicine, or related specialty with inpatient care experience.
• 3+ years of experience performing DRG audits, utilization management, or clinical validation reviews.
• Deep familiarity with ICD-10-CM/PCS, AHA Coding Clinic guidance, and CMS DRG policies.

Nice To Haves

• Experience working with AI-powered or technology-enabled audit platforms.
• Demonstrated ability to translate clinical reasoning into structured or algorithmic formats.
• Strong written communication skills for audit documentation and collaborative product feedback.
• Comfort working in cross-functional teams (clinical, coding, engineering, product).

Responsibilities

• Conduct DRG reviews to validate principal and secondary diagnoses, procedures, and associated coding.
• Apply industry standard guidelines, coding rules, and organizational policies to each case.
• Deliver clear, well-documented rationale for each determination, suitable for appeal-ready communication.
• Translate case-based reasoning and medical judgment into structured feedback for the AI adjudicator.
• Flag nuanced 'maybe' cases, conflicting data, or gray zones to inform how the AI handles uncertainty.
• Collaborate with policy and engineering teams to refine policy JSONs, decision trees, and narrative outputs.
• Identify opportunities to capture clinical nuance (progression of illness, comorbid interactions) that improve AI accuracy.
• Serve as a subject matter expert for coding teams, nurses, and data scientists.
• Provide input on audit guidelines, clinical validation criteria, and education materials.
• Participate in quality improvement initiatives to enhance reviewer consistency and platform performance.

Benefits

• Work from anywhere in the US! Machinify is digital-first.
• Full Medical/Dental/Vision for employees & their families w/ 100% premium coverage options!
• Flexible and trusting environment where you’ll feel empowered to do your best work.
• Unlimited PTO.
• Competitive compensation package, 401(k) sponsorship.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree
• Number of Employees: 1,001-5,000 employees