Chief Medical Officer

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September 30

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Machinify, Inc.

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Artificial Intelligence • Healthcare Insurance • Fintech

Machinify, Inc. is a company specializing in artificial intelligence solutions for the healthcare industry, particularly in optimizing payment processes and enhancing payment integrity. Their product suite, including Machinify Audit and Machinify Pay, is designed to automate and improve the accuracy of medical claims review, identifying billing and coding errors, and reducing administrative costs. Machinify's AI-driven platform covers millions of healthcare members and delivers significant financial benefits by efficiently processing medical claims and empowering health plans to tailor their policies. With a focus on transparency, control, and safety in AI, Machinify offers customized solutions that adapt to the specific needs of healthcare providers and contribute to the transformation of healthcare payments.

51 - 200 employees

🤖 Artificial Intelligence

⚕️ Healthcare Insurance

💳 Fintech

💰 $10M Series A on 2018-10

📋 Description

• 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