Genitourinary Medical Director
Artera.net
Chief Medical Officer
Machinify, Inc.
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- Serve as the clinical leader and executive partner to health plan clients; report to the CEO.
- Build trusted partnerships with client Medical Directors, Payment Integrity executives, and senior payer stakeholders.
- Partner with clients to validate results, demonstrate clinical credibility, and drive adoption of payment integrity solutions.
- Collaborate with sales and customer success teams to support business development and long-term partnership growth.
- Shape payer-specific payment policies for accurate enforcement in the Machinify system.
- Provide evidence-based clinical and coding rationale during client audits, appeals and escalations.
- Advise on complex reimbursement constructs across CMS, Medicaid, and commercial plans, including DRG classifications, OPPS/APC, NCCI, CPT/HCPCS, and modifier logic.
- Maintain alignment with authoritative industry standards (CMS NCCI, AMA CPT, ICD-10 guidelines, AHIMA briefs).
- Partner closely with operations, engineering, data science, product, and client services teams to ensure outputs are clinically sound.
- Mentor internal clinicians and guide clinical playbooks and escalation protocols.
- Represent the clinical perspective in product roadmap and innovation initiatives and advance clinical content innovation.
- Shape the platform to diagnose root causes and enable systemic improvements beyond identifying payment errors.
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.
- Demonstrated leadership and ability to translate clinical insights into strategy.
- Preferred: Experience with pharmacy claims, PBM workflows, or claims editing platforms (ClaimCheck, CES, Lyric).
- Preferred: Familiarity with AI/NLP or automation-driven audit workflows.
- Preferred: Advanced degree (MBA, MPH, MHA).
Benefits
- We sponsor!
- Remote work
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
payment integrityreimbursement operationsclaims auditingDRG classificationsOPPS/APCNCCICPTHCPCSmodifier logicevidence-based clinical rationale
Soft skills
leadershipclient engagementmentoringcollaborationstrategic insightcommunicationpartnership buildingclinical credibilityproblem-solvinginnovation
Certifications
MDDOactive medical licenseMBAMPHMHA
