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Hendersonville, North Carolina, United States
Onsite
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
Location: This role is onsite in Hendersonville, TN
About the Opportunity
The Onsite DRG Reviewer is responsible for providing MS-DRG and APR-DRG audits services at provider locations on behalf of our clients This role requires expertise in healthcare payment methodologies and audit and review criteria to target key claims for review and recovery. The DRG Reviewer examines medical records to validate accuracy of the UB and items billed for accurate DRG assignment along with appropriate customer payment policies applied to each case reviewed. The DRG Reviewer must be able to work independently with minimal supervision. Strong customer service skills are required. This position is an onsite audit position that requires the DRG Reviewer to live in the commutable vicinity of Nashville, TN and be able to go onsite daily to the facilities as scheduled.
What You'll Do
General
Education (required)
Certification (at least one of the following is required)
Experience
Computer Equipment and Software
Physical Demands
Pay range: $90,000-$110,000
This is an exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.
EXPECTATIONS:
1. As a salaried “exempt” employee of VARIS, Assistant Managers (AM) are expected to work at a minimum of 40 hours per week or a minimum of 80 hours every two week pay period. VARIS allows some flexibility of work schedules, however, AM’s must work at least 5 hours per day. If less than 5 hours per day are worked, prior approval must be made. Approvals have to be entered into the VARIS time off calendar. AM’s must be disciplined to work independently on a remote basis and have the ability to be flexible with the possibility of working greater than an 8 hour day.
2. AM’s are expected to have each team member within their team achieving at a minimum a 15% find rate and complete at least 2.0 records per validation hour worked. A skill level improvement may be performed periodically by your manager…”A positive skill improvement analysis does not guarantee either an increase in compensation or continuing employment. Raises, if given, are based on a number of factors, such as VARIS, LLC performance and profitability, department or group performance and individual performance.” (see Employee Handbook: Skill Improvement) AM’s must also report as accurately as possible the total hours worked for each task.
3. Appeal responses are expected to be completed at the beginning of each work day. The time involved working on appeal responses is included within the total validation hours worked, not counted separately. AM’s assure that all appeals for their team are complete on time. AM’s assist other AM’s in achieving a quick company wide appeal response.
4. An AM assists CVS’s in producing strong and high quality rationales for any coding change that affects the DRG assignment; using proper grammar, spelling, and punctuation. Rationales should include ICD-9-CM Coding Conventions, Official Coding Guidelines, and AHA Coding Clinic advice to support the DRG change. Rationale letters are written at a level that conveys professionalism and subject matter expertise.
5. An AM assists CVS’s to improve their quality of work and have no more than 2 cases per month (per employee) that are identified as a CVS oversight (or A3). Focused closed case reviews must be at a minimum of 90% accuracy rate. (Refer to the Quality Monitoring Policy and Procedure dated 2/2013)
6. AM’s are expected to attend monthly CVS meetings. Only exceptions are for vacation, sickness or situations where prior approval has been made. If an AM misses a meeting they are required to review the team agenda and contact their Manager for important updates.
7. AM’s are required to work on their coding skills on their own time to be professionally ready for their specific job at VARIS (including ICD-10).
8. AM’s are expected to demonstrate commitment to the VARIS values as described in the employee handbook.
NOTE: The position expectations outlined above are in no way to be construed to be all encompassing.
What We Offer:
The salary for this position is based on an array of factors unique to each candidate: Such as years and depth of experience, set skills, certifications, etc. We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range. Salary is one component of the total compensation package, which includes meaningful equity, excellent healthcare, flexible time off, and other benefits and perks.
Pay range: $90,000 - $105,000, plus quarterly bonus.
