Principal Clinician - Revenue Cycle Management (RCM)

Job description

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. How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1 This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Principal Clinician - Revenue Cycle Management (RCM) based in the United States. This senior clinical leadership role owns the quality and effectiveness of revenue cycle processes supporting AI-powered healthcare workflows.You will ensure clinical documentation, coding, risk adjustment, and denial-management decisions are accurate, compliant, measurable, and financially meaningful.The role combines clinical expertise, revenue cycle strategy, data analysis, and cross-functional leadership in a high-growth healthcare technology environment.You will build the infrastructure needed to monitor coding quality, identify reimbursement risks, strengthen claims outcomes, and reduce avoidable denials.You will also translate clinical and financial insights into improvements across product, engineering, operations, customer success, and clinical workflows.The position offers significant visibility with customers, health plans, health systems, executives, and other healthcare stakeholders.It is an opportunity for an experienced clinical RCM leader to shape how AI is applied to revenue integrity and measurable healthcare outcomes.