---
title: 'Supervisor, Medical Review Audit (Clinical) at Machinify'
canonical: 'https://feeny.ai/job/supervisor-medical-review-audit-clinical-machinify-united-states-e9jy7fsrfvsr'
type: 'job'
last_seen: '2026-11-04'
---

# Supervisor, Medical Review Audit (Clinical) at Machinify

- **Company:** Machinify
- **Location:** United States
- **Work type:** remote
- **Posted:** 2026-10-30
- **Last confirmed live:** 2026-11-04
- **Apply:** https://job-boards.greenhouse.io/machinifyinc/jobs/4472021009

## Job description

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 team of clinical auditors and audit associates; set clear productivity and quality expectations and hold the team to them consistently.
- Conduct regular performance reviews, coaching conversations, and constructive feedback sessions; escalate performance concerns through appropriate Leader and/or HR channels.
- Lead regular team meetings to align priorities, communicate updates, and maintain engagement in a remote environment.
- Monitor and manage time, attendance, and scheduling in accordance with company policy.
- Identify training gaps and coordinate targeted development, including calibration on PDPM classification, skilled need, and level of care determinations; support onboarding of new audit staff.

SNF Audit Oversight & Quality

- Serve as the primary subject matter authority for SNF audit programs; maintain current, working knowledge of Medicare Benefit Policy Manual Chapter 8 coverage requirements, PDPM, the MDS 3.0 RAI Manual, SNF consolidated billing, and Medicare Advantage and commercial SNF reimbursement policy.
- Maintain personal audit proficiency by performing a limited volume of SNF claim reviews; serve as technical resource and escalation point for complex or disputed cases, including skilled need, level of care, and PDPM component disputes.
- Oversee audit determinations on qualifying hospital stays, physician certification and recertification, daily skilled services, and MDS coding accuracy to ensure findings are consistent, defensible, and grounded in the medical record.
- Collaborate with the QA team to translate audit findings and error trends into clear, actionable feedback for auditors, driving continuous improvement in audit accuracy.
- Monitor team inventory and workflow to proactively identify and address backlogs before they impact SLAs.
- Use production and quality data to identify trends, surface opportunities, and present actionable recommendations to leadership.
- Support implementation of new audit concepts, client requirements, and payer-specific SNF guidelines, including changes from the annual CMS SNF PPS final rule.

Cross-Functional & Strategic Contribution

- Provide reporting and operational updates to management on team activity, performance metrics, and emerging issues.
- Collaborate with QA, Appeals, and segment specialists to resolve operational problems and support continuous improvement.
- Maintain current knowledge of SNF PPS rule changes, MDS item set and RAI Manual updates, and CMS program integrity activity affecting SNF claims.
- Participate in client-facing meetings and support provider training activities.
- Support management in capacity planning, needs assessments, and inventory activity for third-party subcontractors as needed.

Knowledge, Skills, and Abilities

- Deep working knowledge of SNF Part A documentation and coverage requirements, including the 3-day qualifying inpatient stay, physician certification and recertification, daily skilled nursing and therapy needs, and the distinction between skilled and custodial care.
- 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.
- Strong data analysis skills; able to synthesize production and quality metrics into operational insights.
- Demonstrated track record of leading teams to performance outcomes, not just managing tasks.
- Comfortable operating with ambiguity; identifies problems and drives to resolution without waiting to be directed.
- Proficient in Microsoft Office Suite (intermediate Excel required); experience with case management or audit platforms preferred.

Required Qualifications

- Active, unrestricted nursing license in good standing; not sanctioned or excluded from Medicare by OIG.
- 3+ years of direct patient care experience, including skilled nursing or post-acute care.
- 2+ years performing medical record audits, MDS review, or clinical reimbursement review in a payer, provider, or SNF setting, with direct experience in SNF Part A claims.
- 3+ years of supervisory or team leadership experience in a comparable production environment, or demonstrated readiness for people leadership through activities such as training, mentorship, subject matter expert, or equivalent; experience managing or supporting remote staff strongly preferred

## Preferred Qualifications

- Resident Assessment Coordinator Certified (RAC-CT or RAC-CTA) through AAPACN.
- Medical coding certification (CPC, CCS, or equivalent).
- Prior experience as an MDS Coordinator, Director of Nursing, or Director of Clinical Reimbursement in a SNF.
- Experience with Medicare Advantage SNF prior authorization or concurrent review.
- Familiarity with SNF appeals workflows, including MAC redeterminations, and payer-provider dispute resolution processes.
- 5+ years of healthcare claims, coding, or clinical reimbursement experience with demonstrated expertise in ICD-10, PDPM, and MDS coding; SNF billing or MDS coordination experience required.

## Equal Employment Opportunity at Machinify

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

## About Machinify

## Company Overview

- **One-liner**: Machinify uses artificial intelligence (AI) to improve healthcare payment integrity, reducing costs and ensuring accurate claims processing for health plans.
- **Entity Type**: Private (Acq – Fin stage; investors include New Mountain Capital, Matrix Partners, Battery Ventures, GV)
- **Headquarters**: Palo Alto, California, United States
- **Founded**: 2015 (per CBInsights) or 2016 (per Built In)
- **Founders**: Not publicly available from provided sources

## Core Business

- **Primary industry**: Healthcare IT – Payment Integrity & Analytics
- **Target customers**: B2B, serving health plans (commercial, Medicare, Medicaid) – 85+ customers including 18 of the top 20 health plans
- **Mission/purpose**: “Reshaping healthcare payment through seamless intelligence” – improving performance and affordability for the entire healthcare ecosystem

## Products & Services

- **AI Operating System for Payment Integrity**: A platform that includes foundation models trained on billions of healthcare data points, a unified data layer (claims, medical records, contracts, policies), task‑specific intelligent agents, and feedback loops for continuous improvement.
- **Payment Integrity Solutions**: Products cover the full spectrum of payment integrity interventions (e.g., DRG review, outpatient audit, subrogation, specialty recovery, claims editing). Deployment models include fully insourced, hybrid, or fully managed.

## Market Standing

- **Valuation / Market Cap**: Not disclosed
- **Key Metric**: Total funding $10.68M (latest round: Acq – Fin; investors include New Mountain Capital, Matrix Partners, Battery Ventures, GV, Paycheck Protection Program, and others)
- **Notable Investors/Partners**: New Mountain Capital, Matrix Partners, Battery Ventures, GV (Google Ventures)
- **Growth Signals**:
  - 85+ customers, including 18 of the top 20 health plans
  - Covers 270M member lives across commercial, Medicare, and Medicaid
  - Over $6B in annual cost avoidance and recoveries realized
  - Currently posting ~48 open roles on Greenhouse (as of search date)

## Competitive Advantages

- **AI‑native platform** trained on billions of healthcare data points, combining foundation models, unified data, and task‑specific agents for high‑precision results
- **Deep domain expertise** – the team brings 40+ years of combined experience in healthcare payment accuracy
- **Flexible deployment** (insourced, hybrid, fully managed) adapts to customer strategy
- **Proven scale** (270M member lives, top health plans) demonstrates trust and effectiveness

## Strategic Focus

- **Expanding payment integrity interventions** across the full care continuum (commercial, Medicare, Medicaid)
- **Continuous improvement** through human‑in‑the‑loop feedback loops
- **Investing in AI safety and transparency** while scaling platform capabilities

## Why Work Here

- **Culture**: Values-driven (Think Big, Be Humble, Deliver Results, Ask Why, Optimize for Customer Impact); transparent, collaborative environment
- **Work model**: Fully remote roles available (US‑based), with some roles requiring onsite presence in Palo Alto, La Grange (KY), or Hendersonville (TN). Hybrid schedules are also supported.
- **Technology stack**: Rust, machine learning, large language models, data engineering, cloud processing
- **Career opportunities**: Open positions across Engineering (Rust, Frontend, Backend, Fullstack, Platform), Data Science (NLP, Modeling, Agentic Systems), Product Management, Operations, Clinical & Coding Auditors, and more
- **Perks**: Mission‑driven work with direct impact on healthcare affordability; strong emphasis on accountability and trust

> **Note**: Machinify warns of active hiring scams – legitimate communications always come from official company email addresses and never require payment.

## Sources

1. [machinify.com](https://www.machinify.com/) – Company overview, products, mission
2. [machinify.com/careers](https://www.machinify.com/careers/) – Culture, values, work model
3. [job‑boards.greenhouse.io/machinifyinc](http://job‑boards.greenhouse.io/machinifyinc) – Current job listings (48 roles)
4. [cbinsights.com](https://www.cbinsights.com/company/machinify) – Funding, stage, investors, headquarters, founding year
5. [builtin.com](https://builtin.com/company/machinify) – Office locations, employee count (96), remote/hybrid policy, technology stack

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