Principal Clinician – Revenue Cycle Management, RCM

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🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

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Penguin Ai

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2024

🏥 Healthcare

💼 Consulting

📦 Logistics

🔥 Funding within the last year

💰 $25M Series A on 2025-10

Healthcare • Consulting • Logistics

Penguin Ai is a healthcare-native AI platform that automates administrative workflows for payers and providers. It uses pre-trained, healthcare-specific small language models and agentic digital workers to accelerate prior authorization, claims adjudication, medical coding, and denials management, aiming to cut administrative waste, reduce risk, and recover revenue with measurable ROI in ~90 days. The platform offers secure connectivity, compliance controls, integrations with common healthcare systems, and tools to customize and scale without vendor lock-in.

📋 Description

• Own end-to-end clinical revenue cycle quality across all Penguin AI agents, including documentation integrity, coding accuracy, sampling, and remediation • Build and run clinical documentation improvement and coding-accuracy programs • Establish inter-rater reliability between AI and human coders/reviewers and detect drift, bias, and edge cases • Operationalise CMS, payer, and coding standards with Compliance • Own denials management, including root-cause analysis, appeals strategy, CAPA, and closed-loop learning • Create clinical training and competency frameworks for coding and CDI reviewers • Define clinical and financial metrics, partner with Data/Engineering to instrument Snowflake, and deliver dashboards and customer reports • Produce customer-facing RCM performance reporting, revenue integrity scorecards, and quarterly business reviews • Surface risk-adjustment and reimbursement optimisation insights from HCC and coding activity • Partner across Product, Engineering, Customer Success, Finance, and the CMO • Represent Penguin AI in customer and payer/regulator forums and conference presentations • Establish a repeatable clinical RCM quality program, improve denial and clean-claim/risk-adjustment outcomes, shape product roadmap and policy, and hire and develop initial team members

🎯 Requirements

• 10+ years progressive clinical experience • 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, including denials management, CDI, audits, and regulatory readiness • Working fluency with ICD-10, CPT, HCC/risk-adjustment coding, CMS UM/reimbursement standards including CMS-0057-F, NCQA, URAC, and HEDIS • Ability to read queries and critique metric definitions such as clean claim rate, denial rate, and A/R days • Ability to partner with analytics, finance, and engineering • Outstanding written and verbal communication across clinicians, coders, engineers, and executive audiences • Active and unrestricted US RN license or equivalent clinical licensure • BSN essential • MSN, MHA, MBA, or MPH strongly preferred • Certified Revenue Cycle Representative (CRCR), CCS, CPC, or CDI credential (CCDS/CDIP) is a bonus • Familiarity with Snowflake, Looker, Tableau, Epic/Cerner billing modules, or comparable tooling is a bonus • Experience preparing for or maintaining URAC/NCQA/HITRUST accreditations is a bonus

🏖️ Benefits

• Competitive salary • Medical, vision, and dental coverage • Generous vacation policy and company holidays • A front-row seat in one of healthcare's most exciting AI companies