Principal Clinician - Revenue Cycle Management (RCM)

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.

Why This Role Matters!

Agentic AI only drives revenue if the clinical documentation and coding behind it are defensible. You will build the RCM quality and insights infrastructure that makes Penguin AI's coding, billing, and denials outcomes auditable, defensible, and financially material  turning clinical-financial signal into cleaner claims, fewer denials, and stronger reimbursement for millions of members.

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