Machinify offers AI-powered healthcare payment integrity solutions to enhance claims accuracy, recovery performance, and cost control. Backed by Battery and GV.
About the role
The Medical Review Audit Supervisor is a working supervisor who leads a remote team of clinical auditors performing medical record review, with primary oversight of Skilled Nursing Facility (SNF) audits. This role requires a licensed nurse with SNF clinical and/or reimbursement experience, command of Medicare Part A SNF coverage rules, the Patient Driven Payment Model (PDPM), and MDS 3.0 documentation, and the leadership presence to drive performance, hold the team accountable, and develop staff. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- Command of PDPM case-mix classification, including the PT, OT, SLP, nursing, and NTA components, primary diagnosis clinical category mapping, Section GG functional scoring, and the interrupted stay policy
- Proficiency in MDS 3.0 coding and RAI Manual guidance, including assessment scheduling, look-back periods, and supporting documentation, ability to validate HIPPS codes against the medical record
- Strong understanding of CMS, Medicaid, Medicare Advantage, and commercial payer coverage and payment rules for post-acute care, including SNF level of care criteria
- Proficiency with ICD-10-CM and HCPCS/HIPPS, familiarity with UB-04 institutional claims, SNF bill types, revenue codes, and consolidated billing edits
- Experience interpreting EHRs, including SNF platforms such as Point Click Care (PCC) or MatrixCare, and applying clinical documentation standards to audit determinations
- Ability to read, analyze, and clearly communicate complex clinical and billing findings, verbally and in writing, at all organizational levels
More about this role
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.
The Medical Review Audit Supervisor is a working supervisor who leads a remote team of clinical auditors performing medical record review, with primary oversight of Skilled Nursing Facility (SNF) audits. This role requires a licensed nurse with SNF clinical and/or reimbursement experience, command of Medicare Part A SNF coverage rules, the Patient Driven Payment Model (PDPM), and MDS 3.0 documentation, and the leadership presence to drive performance, hold the team accountable, and develop staff.
Key Responsibilities
Team Leadership & Performance Management
- Directly supervise a...
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