[Remote] Medical Director, DRG Audit & AI Innovation at Machinify

Remote

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

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

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

Skills

Key technologies and capabilities for this role

DRG AuditInpatient CodingClinical ReviewMedical CodingAI InnovationHospital ClaimsCoding GuidelinesDiagnostic ValidationProcedure CodingAI Agent Training

Questions & Answers

Common questions about this position

What qualifications are required for the Medical Director role?

Candidates must have an MD/DO with an active, unrestricted license and board certification in Internal Medicine, Surgery, Family Medicine, or similar fields, along with strong inpatient coding and DRG audit expertise.

What are the main responsibilities in this position?

The role involves conducting DRG clinical reviews to validate diagnoses, procedures, and coding; providing structured feedback to refine the AI adjudicator; and serving as a subject matter expert for quality improvement and education.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What is the salary or compensation for this role?

This information is not specified in the job description.

What makes a strong candidate for this Medical Director position?

A strong candidate is a board-certified physician with DRG audit expertise who can deliver high-quality reviews, provide clear rationales, and collaborate with engineering teams to improve AI accuracy through structured feedback.

Machinify

AI-driven solutions for healthcare administration

About Machinify

Machinify provides AI-driven solutions to improve decision-making in the healthcare industry. Its platform helps health plans, payers, and providers optimize their operations, particularly in areas like claims processing and utilization management. The applications offered by Machinify can be quickly deployed, allowing clients to see immediate returns on investment. This focus on rapid implementation sets Machinify apart from competitors, as healthcare organizations increasingly seek cost efficiency and better patient outcomes. The company's goal is to enhance operational efficiency and help clients manage healthcare expenditures more effectively.

Palo Alto, CaliforniaHeadquarters

2016Year Founded

$15.2MTotal Funding

SERIES_ACompany Stage

AI & Machine Learning, HealthcareIndustries

51-200Employees

Benefits

Medical, dental, & vision

Flexible work environment

Generous PTO

Competitive salary

Equity

401(k)

Sponsorship

Generous L&D Reimbursement policy

Risks

Integration challenges with Evolent Health could disrupt Machinify's operations.

Slow adoption of new technologies in healthcare may hinder Machinify's rapid deployment.

Reliance on a few large clients poses a risk if they switch providers.

Differentiation

Machinify leverages AI to optimize healthcare decision-making and administrative processes.

The company offers rapid deployment of AI applications for immediate ROI in healthcare.

Machinify's AI platform addresses the entire healthcare claims lifecycle efficiently.

Upsides

AI-driven automation in healthcare claims processing is gaining significant traction.

The healthcare AI market is projected to reach $45.2 billion by 2026.

Machinify's AI solutions reduce administrative costs and improve patient care access.

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