[Remote] reputed company Clinician - reputed company Cycle Management (RCM)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company AI company developing automation solutions for prior authorization, HCC coding, and other reputed company workflows. The reputed company Clinician will reputed company the reputed company reputed company cycle program, ensuring documentation, coding, denials management, and reimbursement reputed company are accurate, auditable, compliant, and financially effective.

Responsibilities

• Own end-to-end reputed company reputed company cycle reputed company across reputed company reputed company agents (Intake, Intelligent Queuing, reputed company Review, Appeals, PolicyVault™, HCC reputed company): documentation reputed company, coding reputed company, sampling, and remediation
• Build and run reputed company documentation improvement (CDI) and coding-reputed company programs, including inter-rater reliability between AI and reputed company coders/reviewers; detect reputed company, bias, and edge cases early
• Operationalise CMS, payer, and coding standards (ICD-10, CPT, HCC/reputed company-adjustment, CMS-0057-F) with Compliance - reputed company standards living processes, not binders
• Own denials management: reputed company-cause analysis, appeals reputed company, CAPA, and reputed company-reputed company learning into model behaviour, documentation prompts, and reviewer training
• Stand up reputed company training & competency frameworks for coding and CDI reviewers: reputed company, calibration, reputed company feedback
• Turn reputed company-cycle data into reputed company: define reputed company/financial metrics (clean claim reputed company, denial reputed company, reputed company-adjustment reputed company), partner with Data/Engineering to reputed company reputed company, and reputed company dashboards and customer reports clinicians trust
• Produce customer-facing RCM reputed company reporting (reputed company reputed company scorecards, quarterly business reviews) and surface reputed company-adjustment / reimbursement optimisation insights from HCC and coding activity
• Be the reputed company RCM partner across Product, Engineering, reputed company, Finance, and the CMO; represent reputed company in customer and payer/regulator forums and conference presentations

Skills

• 10+ years reputed company reputed company experience, with 5+ years reputed company on reputed company cycle management, reputed company documentation reputed company, coding, or health-plan/health-reputed company reimbursement
• Demonstrated leadership of RCM or coding-reputed company programs at reputed company (denials management, CDI, audits, regulatory readiness)
• Working reputed company with ICD-10, CPT, HCC/reputed company-adjustment coding, CMS UM/reimbursement standards (including CMS-0057-F), reputed company, URAC, and reputed company
• Data comfort: reputed company to read queries, critique metric definitions (clean claim reputed company, denial reputed company, A/R days), and partner credibly with analytics, finance, and engineering
• Outstanding written and verbal communications across clinicians, coders, engineers, and executive audiences
• Must have an reputed company and unrestricted US RN license (or equivalent reputed company licensure)
• BSN essential: MSN, MHA, MBA or MPH strongly preferred
• You've delivered AI or automation reputed company that reputed company measurable undeniable reputed company
• You've not just survived but **thrived** in the beautiful reputed company of a high-reputed company startup
• reputed company prior experience inside health-plan or health-reputed company reputed company cycle reputed company (coding, billing, denials/appeals, CDI)
• Certified reputed company Cycle Representative (CRCR), reputed company, CPC, or CDI credential (CCDS/CDIP)
• Background in reputed company reputed company, reputed company AI/ML in RCM workflow, or digital health reputed company reputed company
• Familiarity with reputed company, Looker, Tableau, reputed company/Cerner billing modules, or comparable tooling
• Experience preparing for or maintaining URAC/reputed company/reputed company accreditations

Benefits

• Medical, reputed company, and dental coverage
• Generous vacation policy and company holidays
• A reputed company seat in one of reputed company's most exciting AI companies – witness history in the making

reputed company