Machinify · 3 months ago
Chief Medical Officer
United States
Full-time
Remote
Director/Executive
10+ years expMachinify is a leading healthcare intelligence company focused on delivering value and efficiency to health plan clients. They are seeking a Chief Medical Officer to serve as a clinical leader, drive client relationships, guide payment integrity policy, and represent the clinical voice in product innovation.
AnalyticsArtificial Intelligence (AI)Business IntelligenceMachine LearningPredictive AnalyticsSaaS
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, 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
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
Qualification
Required
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)
Familiarity with AI/NLP or automation-driven audit workflows
Advanced degree (MBA, MPH, MHA)
Company
Machinify
Machinify is a SaaS platform that enables non-technical enterprises to build AI-powered products and processes.
1001-5000 employees
H1B Sponsorship
Machinify has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (12)
2024 (6)
2023 (3)
2022 (3)
2021 (4)
2020 (5)
Funding
Current Stage
Late StageTotal Funding
$12.79MKey Investors
Battery Ventures
2025-01-10Acquired
2018-10-08Series A· $10M
2016-03-15Seed· $2.79M
Leadership Team
Edward Lichty
Strategic Operations
Prasanna Ganesan
EVP & Chief Product Officer
Recent News
2025-12-19
Dallas Morning News
2025-10-24
globallegalchronicle.com
2025-10-24
Company data provided by crunchbase