DRG QA and Trainer (Healthcare AI)

TL;DR

DRG QA and Trainer (Healthcare AI): Overseeing quality assurance of DRG Reviewers and ensuring adherence to clinical and coding standards with an accent on auditing accuracy and staff training. Focus on implementing clinical validation guidelines, providing detailed performance feedback, and developing training resources for medical coding specialists.

Location: Remote (Must be based in the US)

Salary: $100,000–$120,000 + Quarterly Bonus

Company

hirify.global is a healthcare intelligence company providing an AI-powered platform to maximize financial outcomes and efficiency for health plans.

What you will do

• Audit and review the work of DRG Reviewers for accuracy, compliance, and alignment with coding and clinical validation guidelines.
• Provide detailed, constructive feedback to reviewers to improve performance and quality results.
• Conduct supplemental training sessions for new hires and existing staff on DRG methodologies and proprietary tools.
• Develop training materials and resources in collaboration with the educator.
• Generate reports on QA results and the effectiveness of training sessions for management.
• Serve as a subject matter expert for complex clinical cases and procedures.

Requirements

• Associate or bachelor’s degree in nursing, health information management, or a related field.
• Certification in RHIA, RHIT, CCDS, CDIP, or CCS is required.
• 2+ years of experience in inpatient claims auditing, quality assurance, or clinical documentation integrity.
• 1+ year of experience in a training or mentoring capacity.
• Strong knowledge of DRG methodologies (MS & APR), ICD-10-CM/PCS coding, and UHDDS definitions.
• Must be based in the United States.

Culture & Benefits

• Digital-first environment with the ability to work from anywhere in the US.
• Comprehensive Medical, Dental, and Vision insurance offerings.
• 401(k) plan with company match.
• FSA/HSA and tuition reimbursement.
• Flexible and trusting work environment designed to empower employees.