Backed by Battery and GV.
About the role
Machinify is redefining Payment Integrity through smarter technology, richer data, and intelligent automation. We are seeking a physician leader to help build the next generation of claims editing and make healthcare payments more accurate and affordable. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- MD or DO from an accredited medical school with an active, unrestricted U.S. medical license
- Significant clinical practice experience and an understanding of real-world provider workflows
- Deep, current knowledge of CPT, HCPCS, ICD-10-CM, NCCI, coding guidelines, documentation requirements, and reimbursement methodologies
- Experience in claims editing, Payment Integrity, coding, utilization management, payer operations, claims operations, or a related field
- Experience building or operating a repeatable clinical content or editing process at scale, beyond authoring individual rules
- Ability to translate complex clinical and coding scenarios into actionable editing logic
More about this role
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
Machinify is redefining Payment Integrity through smarter technology, richer data, and intelligent automation. We are seeking a physician leader to help build the next generation of claims editing and make healthcare payments more accurate and affordable.
As Lead Medical Director - Claims Editing , you will lead clinical development and governance of editing content. You will identify opportunities, validate clinical concepts, evaluate performance, and ensure edits are evidence-based, defensible, measurable, and scalable.
This is a build-and-scale role at the intersection of clinical...
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