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.
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
