[Hiring] Training Specialist, Medical Review Audit @Machinify

Role Description

The Training Specialist, Medical Review Audit – Clinical RN owns the design, development, and delivery of training programs for clinical audit staff specializing in Inpatient Psychiatric Facility (IPF) and Inpatient Rehabilitation Facility (IRF) claims. This is not a generalist training role. The right candidate brings deep, working knowledge of IPF and IRF documentation standards, payment systems, and medical necessity criteria alongside a demonstrated track record of building training programs that produce measurable improvements in auditor accuracy, productivity, and quality outcomes. This role requires an active nurse who can function as both a clinical subject matter expert and a skilled adult learning practitioner.

Key Responsibilities

• Training Program Design & Development
  • Design, build, and maintain comprehensive training curricula for clinical audit nurses and audit associates covering IPF and IRF claim review, documentation requirements, medical necessity criteria, coding, and payer policy.
  • Develop structured training programs, job aids, reference materials, and assessment tools for new hire onboarding, ongoing competency, performance improvement, and new program implementations.
  • Translate complex clinical, regulatory, and payer-specific requirements into clear, audit-ready training content appropriate for the intended audience.
  • Maintain and update training materials on a continuous basis to reflect changes in CMS payment rules, LCD/NCD policy, coding guidelines, and client-specific requirements affecting IPF and IRF audits.
  • Build and manage training content within the Learning Management System (LMS); ensure materials are current, accessible, and structured for effective delivery in a remote environment.
• Training Delivery & Outcomes
  • Plan, coordinate, and deliver new hire training and ongoing education across 1:1, small group, and virtual classroom formats.
  • Track and report training completion, assessment scores, and post-training performance metrics; use data to evaluate program effectiveness and drive continuous improvement.
  • Identify training gaps through QA results, audit performance data, appeals trends, and direct observation; develop and execute targeted remediation plans.
  • Conduct User Acceptance Testing on new audit platform workflows and reporting enhancements; incorporate findings into training materials before go-live.
  • Deliver training on new client implementations, new audit programs, and updated audit concepts in coordination with operations and management.
• Clinical Subject Matter Expertise
  • Serve as the primary subject matter authority for IPF audit training.
  • Serve as the primary subject matter authority for IRF audit training.
  • Maintain current, working knowledge of IPF PPS and IRF PPS payment rules, ICD-10-CM/PCS coding applicable to inpatient psychiatric and rehabilitation claims.
  • Monitor changes to CMS regulations, LCD/NCD coverage criteria, coding guidelines, and clinical standards; proactively update training content and communicate changes to audit staff.
  • Provide consultative input on audit platform requirements, workflow design, and business rule development as they relate to IPF and IRF audit processes.
• Collaboration & Program Support
  • Partner with operations management, QA, and compliance to align training programs with business objectives and client contractual requirements.
  • Support management in documenting workflows and process improvement plans; contribute to training-related components of new concept implementation.
  • Provide input on training scheduling to ensure delivery meets operational timelines, legal requirements, and contractual obligations.

Qualifications

• Deep working knowledge of IPF payment and documentation requirements.
• Strong command of IRF coverage and documentation requirements.
• Ability to distinguish and articulate medical necessity criteria across levels of care.
• Proficiency with ICD-10-CM/PCS coding for inpatient psychiatric and rehabilitation claims.
• Demonstrated ability to design and deliver adult learning programs that produce measurable, documented outcomes.
• Proficiency with instructional design principles, needs assessment methodology, and learning evaluation frameworks.
• Experience developing and managing training content in a Learning Management System (LMS).
• Strong data interpretation skills.
• Familiarity with utilization management tools such as MCG or InterQual.
• Proficient in Microsoft Office Suite.
• Clear, precise communicator.

Requirements

• Active, unrestricted nursing license in good standing.
• AHIMA or AAPC coding certification required.
• Bachelor’s degree in Nursing, Health Information Management, Education, or a related field required.
• 3+ years of direct experience performing medical record audits in IPF and/or IRF claims.
• Direct clinical experience in an inpatient psychiatric or inpatient rehabilitation setting required.
• 3+ years of experience developing and delivering clinical or healthcare training programs.
• Demonstrated experience identifying training gaps from performance data and implementing remediation programs.

Preferred Qualifications

• Master’s degree in Nursing, Education, Health Informatics, or a related field.
• Clinical background in inpatient psychiatric nursing.
• Clinical background in inpatient rehabilitation nursing.
• Experience with mental health parity compliance review.
• Prior experience in a RAC, MAC, TRICARE, or commercial payer audit environment.
• Experience conducting User Acceptance Testing on audit platform or reporting system enhancements.
• Experience contributing to provider education, audit edit development, or medical policy improvement.

Company 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.