{"id":204620,"url":"https://alion.io/job/machinify-medical-review-nurse-ii-snfmds-auditor","title":"Medical Review Nurse II - SNF/MDS Auditor","company":{"id":7119,"name":"Machinify","domain":"machinify.com","url":"https://alion.io/company/machinify","size_band":"51-200","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Greenhouse","truth_index":{"grade":"A","score":95,"open_postings":36,"ghost_share":0,"stale_share":0,"repost_share":0,"time_to_fill_p50_days":163,"computed_at":"2026-09-25T05:45:01Z"}},"role":"Finance","role_family":"Finance","seniority":"middle","employment_type":null,"work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"posting_text","remote_working_hours":null,"hiring_geo_confidence":"structured","locations":[],"countries":[],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":85000,"max":100000,"currency":"USD","period":"year","gross":null,"usd_annual":100000},"salary_estimate":null,"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Office","optional":false}],"status":"live","first_seen_at":"2026-08-07T20:59:24Z","employer_posted_date":"2026-08-07","last_verified_at":"2026-09-25T22:34:19Z","board_verified":true,"closed_at":null,"days_open":49,"trust":{"level":"ok","repost_count":0,"flags":[],"days_open":48},"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.\nPlease read the description and requirements carefully. This role requires specific MDS experience, so if you do not have that experience then please consider applying for one of our other Medical Review Nurse roles, which may be a better fit for you. Thank you!\nJob Summary:\nThe Medical Review Nurse II - SNF/MDS primarily performs Skilled Nursing Facility (SNF) medical claims audit reviews. As a MR Nurse, you will join a team of experienced medical auditors performing retrospective and prepayment audits on claims for Government and Commercial Payers. You will work remotely in a fast-paced and dynamic environment and be part of a multi-location team.\nPay range: This is an exempt salaried position with an expected starting range of $85,000 - 100,000 annually. Actual offered amounts will be dependent on individual candidate evaluations.\nKey Responsibilities:\nAuditing claims for medically appropriate services provided in skilled nursing facility settings while applying appropriate medical review guidelines, policies and rules.\nDocument all findings referencing the appropriate policies and rules.\nGenerate letters articulating audit findings.\nSupport audit findings during the appeals process if requested.\nWork collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.\nWork in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.\nKeep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.\nWork with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows.\nAssist with QA functions and training team members.\nParticipate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.\nInterface with and support the Medical Director and cross train in all clinical departments/areas.\nOther duties as required to meet business needs.\nKnowledge, Skills and Abilities Needed:\nExperience with and deep knowledge of ICD-9, ICD-10, HCPCS coding.\nKnowledge of PDPM payment Items contributing to payment methodologies.\nAbility to maintain high quality work while meeting strict deadlines.\nExcellent written and verbal communication skills.\nAbility to manage multiple tasks including desk audits and claims review.\nMust be able to independently work within Microsoft Office products including Word, Excel, PPT, to Include creating/saving documents in folders, setting up and utilizing spreadsheets, copying and pasting data from one document to another.\nMust be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload.\nEffectively work independently and as a team, in a remote setting.\nRequired Qualifications:\nActive unrestricted RN license in good standing, is required.\nMust not be currently sanctioned or excluded from the Medicare program by the OIG.\nMinimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.\nOne (1) or more years’ experience with MDS/ RAI process.\nOne (1) or more years' experience performing medical records review.\nOne (1) or more years' experience in health care claims that demonstrates expertise in ICD-9/ICD-10 coding guidelines and how it relates to the MDS RAI Process.\nComprehension of the Uniform Medical Billing Form (UB-04) and application to the MDS billing process.\nPreferred Qualifications:\nStrong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.\nStrong preference for Understanding and in-depth comprehension of PDPM HIPPS codes including HIPPS Clinical Categories and the components that comprise the HIPPS categories.\nKnowledge of RUG and LOC commercial payors preferred but not required.\nUnderstanding of Medicare Benefit Payment Manual and Medicare Claims Processing Manual for SNF\nEqual Employment Opportunity at Machinify\nWe 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. 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