[Remote] Chief Medical Officer at Machinify

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

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
Experience with pharmacy claims, PBM workflows, or claims editing platforms (ClaimCheck, CES, Lyric)
Familiarity with AI/NLP or automation-driven audit workflows
Advanced degree (MBA, MPH, MHA)
Experience with AI/NLP or automation-driven audit workflows

Responsibilities

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
Maintain alignment with authoritative industry standards (CMS NCCI, AMA CPT, ICD-10 guidelines, AHIMA briefs)
Cross-functional collaboration with operations, engineering, data science, product, and client services teams
Mentor internal clinicians and guide clinical playbooks and escalation protocols
Represent the clinical perspective in product roadmap and innovation initiatives
Advance clinical content innovation to ensure defensibility, scalability, and impact
Shape the platform to move beyond identifying payment errors to diagnosing root causes and enabling systemic improvements

Skills

Machinify

AI-driven solutions for healthcare administration

About Machinify

Machinify provides AI-driven solutions to improve decision-making in the healthcare industry. Its platform helps health plans, payers, and providers optimize their operations, particularly in areas like claims processing and utilization management. The applications offered by Machinify can be quickly deployed, allowing clients to see immediate returns on investment. This focus on rapid implementation sets Machinify apart from competitors, as healthcare organizations increasingly seek cost efficiency and better patient outcomes. The company's goal is to enhance operational efficiency and help clients manage healthcare expenditures more effectively.

Palo Alto, CaliforniaHeadquarters

2016Year Founded

$15.2MTotal Funding

SERIES_ACompany Stage

AI & Machine Learning, HealthcareIndustries

51-200Employees

Benefits

Medical, dental, & vision

Flexible work environment

Generous PTO

Competitive salary

Equity

401(k)

Sponsorship

Generous L&D Reimbursement policy

Risks

Integration challenges with Evolent Health could disrupt Machinify's operations.

Slow adoption of new technologies in healthcare may hinder Machinify's rapid deployment.

Reliance on a few large clients poses a risk if they switch providers.

Differentiation

Machinify leverages AI to optimize healthcare decision-making and administrative processes.

The company offers rapid deployment of AI applications for immediate ROI in healthcare.

Machinify's AI platform addresses the entire healthcare claims lifecycle efficiently.

Upsides

AI-driven automation in healthcare claims processing is gaining significant traction.

The healthcare AI market is projected to reach $45.2 billion by 2026.

Machinify's AI solutions reduce administrative costs and improve patient care access.

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