Training Specialist, Medical Review Audit – Clinical RN

Machinify
United States
Workplace: RemoteFull timeFunction: Education & TrainingExperience: 3+ yearsEducation: bachelorsSkills: ["Communication","Data interpretation","Instructional design","Continuous improvement","Collaboration"]

Design, build, and deliver adult learning programs for clinical audit nurses reviewing IPF and IRF claims. Serve as the primary subject matter expert on inpatient psychiatric and inpatient rehabilitation medical necessity, documentation, and payment rules, translating complex clinical and payer requirements into audit-ready training content. Own LMS-based curricula, deliver remote training, measure outcomes using audit/QA/appeals data, and run remediation and UAT to improve audit accuracy and quality.

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FursaFursa
Machinify
Machinify
2 days ago

Training Specialist, Medical Review Audit – Clinical RN

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Source: Company careers pageValidated by: Fursa AI
Last checked: 22 hours agoStatus: Live

Job Summary

Design, build, and deliver adult learning programs for clinical audit nurses reviewing IPF and IRF claims. Serve as the primary subject matter expert on inpatient psychiatric and inpatient rehabilitation medical necessity, documentation, and payment rules, translating complex clinical and payer requirements into audit-ready training content. Own LMS-based curricula, deliver remote training, measure outcomes using audit/QA/appeals data, and run remediation and UAT to improve audit accuracy and quality.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Education & Training
Seniority: Mid level

Key Responsibilities

  • •Design and maintain training curricula for clinical audit staff covering IPF/IRF claim review, documentation, medical necessity criteria, coding, and payer policy.
  • •Develop onboarding, competency, and performance improvement training materials, including job aids, reference materials, and assessment tools.
  • •Translate complex clinical, regulatory, and payer-specific requirements into audit-ready training content and keep materials updated with CMS and client policy changes.
  • •Plan and deliver new hire and ongoing education in 1:1, small group, and virtual classroom formats; track completion and performance metrics and use results to drive continuous improvement.
  • •Conduct UAT on new audit platform workflows/reporting enhancements and incorporate findings; lead targeted remediation when training gaps are identified via QA/audit/appeals data.

Key Requirements

  • •Active, unrestricted nursing license in good standing; not sanctioned or excluded from the Medicare program by OIG.
  • •AHIMA or AAPC coding certification required (CPC, CCS, CCS-P, RHIT, or equivalent).
  • •Bachelor’s degree in Nursing, Health Information Management, Education, or related field.
  • •3+ years of direct medical record audit experience in IPF and/or IRF claims in a payer or similar audit organization.
  • •3+ years developing and delivering clinical/healthcare training programs with documented, measurable outcomes; remote learning delivery required.
Experience:3+ yearsHealthcareHealth insuranceMedical reviewClinical audits
Education:Bachelor's
Skills:CommunicationData interpretationInstructional designContinuous improvementCollaboration
Licenses:Active, unrestricted nursing license
Certifications:AHIMAAAPCCPCCCSCCS-PRHIT
Languages:English
Tech Stack:Learning Management System (LMS)Kirkpatrick modelMicrosoft Office SuitePowerPointWordExcelICD-10-CMICD-10-PCSIPF PPSIRF PPSDSM-5MCGInterQual

Company Brief

Machinify
Provides AI-driven predictive maintenance and asset-monitoring solutions for manufacturing and industrial operations, using IoT sensor data and machine learning to reduce downtime, optimize performance, and extend equipment life.
Industry: Industrial Automation
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