Chief Medical Officer

Machinify

Completely RemoteFull TimeHealthcare & Telemedicine
Posted 3 months ago

This role is no longer accepting applications.

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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.

  1. 01MD or DO with active license
  2. 0210+ years payment integrity or claims auditing
  3. 03Expertise in DRG, APCs, CPT/HCPCS
  4. 04CMS, Medicare, Medicaid rules
  5. 05Executive client engagement experience
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