Chief Medical Officer
Machinify
Completely RemoteFull TimeHealthcare & Telemedicine
Posted Today
Job description
Responsibilities
- Build trusted partnerships with health plan Medical Directors and Payment Integrity executives
- Drive payment integrity policy and validate results with clinical credibility
- Advise on complex reimbursement constructs including DRG, APCs, CPT/HCPCS, and CMS rules
- Represent the clinical perspective in product roadmap and innovation initiatives
- Mentor internal clinicians and guide clinical playbooks and escalation protocols
Requirements
- MD or DO with active license
- 10+ years in payment integrity, reimbursement operations, or claims auditing
- Expertise across inpatient, outpatient, and professional claims (DRG, APCs, CPT/HCPCS, modifier logic)
- Strong knowledge of CMS, Medicare, Medicaid, and commercial payer adjudication rules
- Proven executive-level client engagement experience
Preferred Qualifications
- Experience with pharmacy claims, PBM workflows, or claims editing platforms
- Familiarity with AI/NLP or automation-driven audit workflows
- Advanced degree (MBA, MPH, MHA)
About the Company
Machinify is a leading healthcare intelligence company delivering AI-powered payment integrity solutions to over 60 health plans representing more than 160 million lives.
Skills & tools
HealthcareAINLPClaims AuditingPayment Integrity
What the team is looking for
Use this list as a quick fit check before you apply.
- 01MD or DO with active license
- 0210+ years payment integrity or claims auditing
- 03Expertise in DRG, APCs, CPT/HCPCS
- 04CMS, Medicare, Medicaid rules
- 05Executive client engagement experience
Machinify
Job details
- Work model
- Completely Remote
- Commitment
- Full Time
- Category
- Healthcare & Telemedicine
- Posted
- Today