Medical Director, AI-Driven Claims Editing & Strategy

Machinify; United States; On-site; USD 250,000 - 350,000; Full time

Job summary

Machinify seeks a Lead Medical Director - Claims Editing to spearhead clinical editing strategy and governance for a scalable AI-enabled platform. You will translate clinical and coding developments into actionable content, monitor edit performance, and ensure defensible, evidence-based edits.

You will partner with Product, Engineering, and Operations to shape content, evaluate AI capabilities, and advise health plan clients on outcomes and improvements.

Qualifications

• MD or DO with an active US medical license and clinical practice experience.
• Deep knowledge of CPT, HCPCS, ICD-10-CM, NCCI, and reimbursement methodologies.
• Experience in claims editing, Payment Integrity, coding, or payer operations.
• Experience building or operating a scalable clinical content or editing process.

Responsibilities

• Lead clinical editing strategy and governance, translating developments into actionable editing concepts.
• Define measures and monitor performance including edit accuracy and savings.
• Shape AI-enabled product content and establish clinical oversight safeguards.
• Advise health plan clients and present rationale behind editing concepts.
• Represent the clinical perspective in strategy, prioritization, and roadmap decisions.

Skills

Clinical editing

Coding knowledge

Data analysis

Cross-functional collaboration

AI awareness

Product strategy input

Education

MD or DO with US license

CPC/CCS certification

Tools

Coding systems knowledge

Job description

Machinify seeks a Lead Medical Director - Claims Editing to spearhead clinical editing strategy and governance for a scalable AI-enabled platform. You will translate clinical and coding developments into actionable content, monitor edit performance, and ensure defensible, evidence-based edits.

You will partner with Product, Engineering, and Operations to shape content, evaluate AI capabilities, and advise health plan clients on outcomes and improvements.