🛠 Tech Stack

💼 About This Role

You'll serve as the clinical leader and executive partner to health plan clients, driving trusted relationships and guiding payment integrity policy. Your core impact will be shaping AI-powered platform content to maximize financial outcomes and reduce healthcare costs. This role emphasizes strategic influence with executive-level stakeholders.

🎯 What You'll Do

• Build trusted partnerships with client Medical Directors and senior payer stakeholders.
• Shape payer-specific payment policies for accurate enforcement in the Machinify system.
• Provide evidence-based clinical and coding rationale during client audits and escalations.
• Represent the clinical perspective in product roadmap and innovation initiatives.

📋 Requirements

• MD or DO with active license.
• 10+ years in payment integrity, reimbursement operations, or claims auditing.
• Expertise across inpatient, outpatient, and professional claims (DRG, APCs, CPT/HCPCS, modifier logic).
• Proven executive-level client engagement experience.

✨ Nice to Have

• Experience with pharmacy claims, PBM workflows, or claims editing platforms (ClaimCheck, CES, Lyric).
• Familiarity with AI/NLP or automation-driven audit workflows.
• Advanced degree (MBA, MPH, MHA).

🎁 Benefits & Perks

• 🏥 Comprehensive health coverage
• 💰 Competitive compensation package
• 🏖️ Flexible remote work
• 📈 Professional development opportunities