Principal Clinician - Revenue Cycle Management (RCM)

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Principal Clinician - Revenue Cycle Management (RCM) based in the United States. This senior clinical leadership role owns the quality and effectiveness of revenue cycle processes supporting AI-powered healthcare workflows. You will ensure clinical documentation, coding, risk adjustment, and denial-management decisions are accurate, compliant, measurable, and financially meaningful. The role combines clinical expertise, revenue cycle strategy, data analysis, and cross-functional leadership in a high-growth healthcare technology environment. You will build the infrastructure needed to monitor coding quality, identify reimbursement risks, strengthen claims outcomes, and reduce avoidable denials. You will also translate clinical and financial insights into improvements across product, engineering, operations, customer success, and clinical workflows. The position offers significant visibility with customers, health plans, health systems, executives, and other healthcare stakeholders. It is an opportunity for an experienced clinical RCM leader to shape how AI is applied to revenue integrity and measurable healthcare outcomes. Own end-to-end clinical revenue cycle quality across AI-powered workflows, including documentation integrity, coding accuracy, sampling, quality assurance, and remediation. Build and operate clinical documentation improvement (CDI) and coding-accuracy programs, including measurement of inter-rater reliability between AI systems and human coders or reviewers. Identify coding drift, potential bias, edge cases, and quality issues early and establish processes for timely remediation. Translate CMS, payer, and industry coding and reimbursement standards into practical, continuously maintained operational processes, including ICD-10, CPT, HCC/risk adjustment, and applicable CMS requirements. Lead denial-management strategy, including root-cause analysis, appeals, corrective and preventive actions (CAPA), and closed-loop improvements to AI behavior, documentation prompts, and reviewer training. Establish clinical training and competency frameworks for coding and CDI reviewers, covering onboarding, calibration, ongoing education, and performance feedback. Define and monitor clinical and financial performance metrics such as clean-claim rate, denial rate, risk-adjustment accuracy, and accounts receivable indicators. Partner with Data and Engineering teams to ensure revenue cycle metrics are accurately instrumented and surfaced through analytics and reporting platforms. Develop customer-facing revenue cycle scorecards, quarterly business reviews, and actionable insights related to reimbursement optimization, HCC activity, and coding performance. Act as the senior clinical RCM partner across Product, Engineering, Customer Success, Finance, Compliance, and executive leadership. Represent the clinical revenue cycle function in customer, payer, regulatory, and industry forums, including presentations and strategic discussions. Build a scalable RCM quality and insights function capable of influencing product strategy, operational policies, customer outcomes, and future team development. Establish documented and repeatable RCM quality programs, reporting processes, and compliance evidence during the first six months. Within the first year, develop a revenue cycle insights practice that contributes to product roadmap decisions, measurable reductions in denials, improved clean-claim and risk-adjustment accuracy, and customer retention. Requirements: 10+ years of progressive clinical experience, including at least 5 years focused on revenue cycle management, clinical documentation integrity, coding, reimbursement, or health-plan/health-system revenue operations. Demonstrated leadership experience overseeing RCM or coding-quality programs at scale, including denial management, CDI, audits, compliance,