Principal Clinician - Revenue Cycle Management (RCM)

Accountabilities:

• • Own end-to-end clinical revenue cycle quality across AI-powered workflows, including documentation integrity, coding accuracy, sampling, quality assurance, and remediation.
  • Build and operate clinical documentation improvement (CDI) and coding-accuracy programs, including measurement of inter-rater reliability between AI systems and human coders or reviewers.
  • Identify coding drift, potential bias, edge cases, and quality issues early and establish processes for timely remediation.
  • Translate CMS, payer, and industry coding and reimbursement standards into practical, continuously maintained operational processes, including ICD-10, CPT, HCC/risk adjustment, and applicable CMS requirements.
  • Lead denial-management strategy, including root-cause analysis, appeals, corrective and preventive actions (CAPA), and closed-loop improvements to AI behavior, documentation prompts, and reviewer training.
  • Establish clinical training and competency frameworks for coding and CDI reviewers, covering onboarding, calibration, ongoing education, and performance feedback.
  • Define and monitor clinical and financial performance metrics such as clean-claim rate, denial rate, risk-adjustment accuracy, and accounts receivable indicators.
  • Partner with Data and Engineering teams to ensure revenue cycle metrics are accurately instrumented and surfaced through analytics and reporting platforms.
  • Develop customer-facing revenue cycle scorecards, quarterly business reviews, and actionable insights related to reimbursement optimization, HCC activity, and coding performance.
  • Act as the senior clinical RCM partner across Product, Engineering, Customer Success, Finance, Compliance, and executive leadership.
  • Represent the clinical revenue cycle function in customer, payer, regulatory, and industry forums, including presentations and strategic discussions.
  • Build a scalable RCM quality and insights function capable of influencing product strategy, operational policies, customer outcomes, and future team development.
  • Establish documented and repeatable RCM quality programs, reporting processes, and compliance evidence during the first six months.
  • Within the first year, develop a revenue cycle insights practice that contributes to product roadmap decisions, measurable reductions in denials, improved clean-claim and risk-adjustment accuracy, and customer retention.

  Requirements:

  • 10+ years of progressive clinical experience, including at least 5 years focused on revenue cycle management, clinical documentation integrity, coding, reimbursement, or health-plan/health-system revenue operations.
  • Demonstrated leadership experience overseeing RCM or coding-quality programs at scale, including denial management, CDI, audits, compliance, and regulatory readiness.
  • Active and unrestricted U.S. RN license or equivalent applicable clinical licensure.
  • Bachelor of Science in Nursing (BSN) is required; MSN, MHA, MBA, or MPH is strongly preferred.
  • Strong working knowledge of ICD-10, CPT, HCC/risk-adjustment coding, and CMS utilization-management and reimbursement standards.
  • Familiarity with healthcare quality and accreditation frameworks such as NCQA, URAC, and HEDIS.
  • Strong understanding of clinical documentation, coding accuracy, claims processes, reimbursement, and denial management.
  • Data-oriented mindset with the ability to interpret queries, evaluate metric definitions, challenge reporting assumptions, and collaborate effectively with analytics, finance, and engineering teams.
  • Ability to understand and critically assess metrics such as clean-claim rate, denial rate, and A/R days.
  • Exceptional written and verbal communication skills, with the ability to engage credibly with clinicians, coders, engineers, customers, and executive stakeholders.
  • Strong strategic thinking, analytical problem-solving, and operational execution skills.
  • Experience working in a high-growth healthcare technology or startup environment is preferred.
  • Experience delivering AI or automation initiatives with measurable healthcare, operational, or financial impact is a strong plus.
  • Direct experience within health-plan or health-system revenue cycle operations, including coding, billing, denials, appeals, or CDI, is preferred.
  • CRCR, CCS, CPC, CCDS, CDIP, or another relevant revenue cycle, coding, or CDI certification is advantageous.
  • Experience in clinical informatics, applied AI/ML for healthcare workflows, or digital health revenue integrity is a plus.
  • Familiarity with Snowflake, Looker, Tableau, Epic, Cerner, or comparable healthcare and analytics platforms is beneficial.
  • Experience preparing for or maintaining URAC, NCQA, HITRUST, or similar healthcare accreditations is advantageous.
  • Comfortable operating in an ambiguous, rapidly changing environment while maintaining high standards of clinical quality, compliance, and accountability.

  Benefits:

  • Competitive salary aligned with senior-level clinical RCM leadership experience and qualifications.
  • Medical, dental, and vision coverage.
  • Generous vacation policy.
  • Company-paid holidays.
  • Opportunity to work remotely within the United States.
  • High-impact role at the intersection of healthcare, clinical operations, revenue cycle management, and artificial intelligence.
  • Significant exposure to product strategy, engineering, customer success, finance, compliance, and executive leadership.
  • Opportunity to build and shape a clinical RCM quality and insights function from the ground up.
  • Ability to influence measurable improvements in claims quality, reimbursement, denial rates, and healthcare administration.
  • Opportunity to contribute to technology designed to reduce administrative burden and improve healthcare outcomes.
  • Dynamic, high-growth environment suited to professionals who enjoy solving complex problems and driving meaningful change.