Head of RCM Systems & AI Compliance

Hike Medical Co•Boston, MA

About The Position

Hike Medical is reinventing musculoskeletal care, starting with feet. Our proprietary AI-vision platform turns a 30 second web based (yes, no sensors) foot scan into precision engineered, 3D-printed insoles that prevent pain before it starts. We're already protecting on-their-feet workforces at Fortune 50 leaders, major health systems, and middle America manufacturers. Fresh off a stealthy round with top tier VCs, we run a fast, no BS, execution first culture out of Boston’s Seaport as we sprint toward $100M ARR and standing with 10M Americans as they step into their shoes daily. First and only PDAC approved 3D printed custom insole in the world 🌎 3 Proprietary AI models that power the experience Two products: One is focused on serving employers & health plans, and the other enables clinics to deliver foot care at a fraction of the cost - creating a virtuous cycle of clinician labelled data. Expanded care access to over 100,000 Americans to date 10x'd revenue from 2023 to 2024, and on track to do the same in 2025. Profitable month-over-month. We are building AI agents that run core back-office workflows for O&P and DME providers. This role owns the compliance logic and human-in-the-loop (HITL) architecture that makes those agents safe, auditable, and trusted by large operators. You will define how: Regulatory rules are translated into systems Humans intervene in AI workflows Edge cases are identified, resolved, and learned from Compliance risk is actively managed at scale This is a foundational role with end-to-end ownership of HITL systems and compliance rules, and a clear mandate to build and lead this function as the platform scales.

Requirements

This role is for someone with deep, hands-on RCM and compliance expertise in DME and/or O&P.
You must have real operating experience with Medicare-heavy workflows and a working understanding of how rules are applied in practice—not just how they are written.
If you have not personally dealt with eligibility checks, prior authorizations, documentation requirements, medical necessity reviews, claims submission, denials, and payer follow-ups in DME or O&P, this role will not be a fit.
Significant hands-on experience in DME and/or O&P revenue cycle management
Deep working knowledge of: Medicare eligibility and benefits
Prior authorization workflows
Referrals and documentation standards
Medical necessity logic
Claims submission, denials, and appeals
Demonstrated ability to interpret and apply complex rules in ambiguous situations
Strong systems thinking and comfort working with engineers
Willingness to operate as a senior IC while building toward a leadership role
Builder mindset with high ownership and accountability
Owning critical systems is.

Nice To Haves

Startup experience is not required.

Responsibilities

Own and define the rulesets governing AI behavior across: Eligibility & benefits verification
Prior authorization
Referrals and documentation requirements
Medical necessity validation
Claims submission, denials, and appeals
Translate payer and Medicare requirements into: Structured rules
Decision trees
Validation logic
Agent instructions
Identify and encode real-world exceptions, workarounds, and edge cases
Continuously audit AI workflows against regulatory and payer requirements
Design HITL workflows that sit directly inside AI-driven processes
Define escalation thresholds based on confidence, risk, and compliance impact
Perform hands-on review and correction of AI output to: Validate accuracy
Train and refine systems
Identify failure modes
Establish quality metrics tied to regulatory exposure, not vanity accuracy
Work directly with engineering to: Implement deterministic rules alongside AI systems
Design feedback loops between human review and agent behavior
Build tools that support rapid iteration and auditability
Serve as the domain authority for how AI should behave inside regulated workflows
Partner directly with customer RCM and compliance teams to: Understand their existing workflows
Surface edge cases and payer-specific nuances
Coordinate on escalations and compliance interpretation
Stay deeply embedded in O&P and DME operational reality
Design and build the HITL function from first principles
Hire, train, and lead HITL specialists as volume and complexity increase
Define operating procedures, escalation models, and performance standards
Build systems that reduce human involvement over time while increasing reliability