Principal Clinician - Revenue Cycle Management (RCM)

Job description

Your Epic Quest as Our Principal Clinician - Revenue Cycle Management! You will own Penguin AI's clinical revenue cycle program - the layer that ensures documentation, coding, and denial-management decisions are accurate, defensible, and revenue-positive. Reporting to our CMO, you'll prove internally, to customers, and to regulators that our agents drive clean claims, accurate risk adjustment, and reduced denials. This is senior clinical RCM leadership: build revenue-cycle quality infrastructure, run coding/CDI accuracy and denials programs, operationalize reimbursement standards, and translate clinical-financial signal into product, ops, and customer outcomes. Why This Role Matters! Agentic AI only drives revenue if the clinical documentation and coding behind it are defensible. You will build the RCM quality and insights infrastructure that makes Penguin AI's coding, billing, and denials outcomes auditable, defensible, and financially material turning clinical-financial signal into cleaner claims, fewer denials, and stronger reimbursement for millions of members. Your Day-to-Day Superpowers: What You’ll Actually Do: Own end-to-end clinical revenue cycle quality across all Penguin AI agents (Intake, Intelligent Queuing, Clinical Review, Appeals, PolicyVault™, HCC engine): documentation integrity, coding accuracy, sampling, and remediation Build and run clinical documentation improvement (CDI) and coding-accuracy programs, including inter-rater reliability between AI and human coders/reviewers; detect drift, bias, and edge cases early Operationalise CMS, payer, and coding standards (ICD-10, CPT, HCC/risk-adjustment, CMS-0057-F) with Compliance - make standards living processes, not binders Own denials management: root-cause analysis, appeals strategy, CAPA, and closed-loop learning into model behaviour, documentation prompts, and reviewer training Stand up clinical training & competency frameworks for coding and CDI reviewers: onboarding, calibration, performance feedback Turn revenue-cycle data into decisions: define clinical/financial metrics (clean claim rate, denial rate, risk-adjustment accuracy), partner with Data/Engineering to instrument Snowflake, and deliver dashboards and customer reports clinicians trust Produce customer-facing RCM performance reporting (revenue integrity scorecards, quarterly business reviews) and surface risk-adjustment / reimbursement optimisation insights from HCC and coding activity Be the clinical RCM partner across Product, Engineering, Customer Success, Finance, and the CMO; represent Penguin AI in customer and payer/regulator forums and conference presentations What Success Looks Like! By month 6 : Documented, repeatable clinical RCM quality program covering all agents with monthly coding-accuracy and denial reporting; closed key compliance evidence requirements in partnership with Compliance and the CMO; delivered first quarterly Revenue Cycle & Clinical Insights review to key health plan/health system clients By month 12 : Established a revenue cycle insights practice that shapes product roadmap, policy, and renewals; measurable reduction in denial rates and improved clean-claim/risk-adjustment accuracy for clients; hired and developed initial team members; become the named clinical RCM credibility voice for customers and partners What We're Looking For: Your Clinical Arsenal! 10+ years progressive clinical experience, with 5+ years focused on revenue cycle management, clinical documentation integrity, coding, or health-plan/health-system reimbursement Demonstrated leadership of RCM or coding-accuracy programs at scale (denials management, CDI, audits, regulatory readiness) Working fluency with ICD-10, CPT, HCC/risk-adjustment coding, CMS UM/reimbursement standards (including CMS-0057-F), NCQA, URAC, and HEDIS Data comfort: able to read queries, critique metric definitions (clean claim rate, denial rate, A/R days), and partner credibly with analytics, finance, and engineering Outstanding written and verbal communications across clinicians, coders, engineers, and executive audiences Bonus Points: Your Secret Weapons! You’ve delivered AI or automation projects that deliver measurable undeniable impact You've not just survived but thrived in the beautiful chaos of a high-growth startup Direct prior experience inside health-plan or health-system revenue cycle operations (coding, billing, denials/appeals, CDI) Certified Revenue Cycle Representative (CRCR), CCS, CPC, or CDI credential (CCDS/CDIP) Background in clinical informatics, applied AI/ML in RCM workflow, or digital health revenue integrity Familiarity with Snowflake, Looker, Tableau, Epic/Cerner billing modules, or comparable tooling Experience preparing for or maintaining URAC/NCQA/HITRUST accreditations The Culture Fit: Join Our Colony! You'll waddle with us if: You like your coffee with a side of delightful chaos You're fuelled by complexity and obsessed with delivering amazing results You want to deliver something that fundamentally matters, transforms healthcare and ultimately saves lives Education & Qualifications: Brainiac Basics Must have an active and unrestricted US RN license (or equivalent clinical licensure) BSN essential: MSN, MHA, MBA or MPH strongly preferred Comp & Perks: Because Even Superheroes Need Support! Competitive salary: We reward greatness! Medical, vision, and dental coverage: Keep you healthy and smiling Generous vacation policy and company holidays: Recharge and conquer! A front-row seat in one of healthcare's most exciting AI companies – witness history in the making Penguin Ai: We're Not Just Building AI, We're Revolutionizing Healthcare! Want to Be Our Principal Clinician - Revenue Cycle Management Maestro? Who We Are: The Penguin Ai Rebellion! We’re not your average AI company - and we don’t want average teammates. Penguin Ai was founded by healthcare veterans who knew the system needed more than hype and half-baked algorithms. We built an AI platform that actually works in healthcare - across Prior Auth, HCC Coding, and all those soul-crushing workflows no one brags about. Our platform is fast to implement (think: 60 days), reduces administrative costs up to 40%, and makes payers look like heroes without writing a line of code. This is AI for the real world of healthcare. And just to put a fine point on it: powerhouses like Snowflake and AWS don't just partner with anyone. Their trust in our platform speaks volumes about our robust, scalable, and secure technology. Our audacious vision was first ignited by our CEO Fawad Butt , whose leadership as Chief Data Officer at both Optum and Kaiser Permanente gave him oversight of healthcare data representing nearly 75% of American lives . So, he didn't just see the problem; he lived it. Fawad understood that healthcare AI couldn't be a bandage - it had to be a purpose-built, battle-ready solution , meticulously crafted for the intricate, human-first world of medicine, not some hastily retrofitted industry software. So with Fawad, who else is steering this iceberg? A dream team boasting over 150 years of combined, hard-won healthcare experience! We're talking about heavy hitters like Kishore, Niki, Nate and Terry… who all bring different successes & expertise from AI & healthcare. These aren't just impressive resumes; they're the architects and masterminds behind a platform that doesn't just process data – it genuinely understands healthcare's pulse. We're growing faster than a penguin on a waterslide and we’re a lways on the hunt for customer-obsessed problem-solvers to help our clients unlock the full potential of their AI investments. This isn’t some futuristic sci-fi movie set, this is AI for the real, gritty, essential world of healthcare where speed & data matter.