Principal Clinician - Revenue Cycle Management (RCM)

Penguin Ai

About The Position

This role is for a Principal Clinician focused on Revenue Cycle Management (RCM) at Penguin AI. The individual will be responsible for the clinical revenue cycle program, ensuring documentation, coding, and denial management decisions are accurate, defensible, and revenue-positive. Reporting to the CMO, this position will demonstrate to internal stakeholders, customers, and regulators that the company's agents drive clean claims, accurate risk adjustment, and reduced denials. This is a senior clinical RCM leadership role that involves building revenue-cycle quality infrastructure, managing coding/CDI accuracy and denials programs, operationalizing reimbursement standards, and translating clinical-financial signals into product, operations, and customer outcomes. The role is crucial for ensuring that agentic AI drives revenue by having defensible clinical documentation and coding, building the RCM quality and insights infrastructure that makes Penguin AI's coding, billing, and denials outcomes auditable, defensible, and financially material.

Requirements

10+ years progressive clinical experience, with 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 (denials management, CDI, audits, regulatory readiness)
Working fluency with ICD-10, CPT, HCC/risk-adjustment coding, CMS UM/reimbursement standards (including CMS-0057-F), NCQA, URAC, and HEDIS
Data comfort: able to read queries, critique metric definitions (clean claim rate, denial rate, A/R days), and partner credibly with analytics, finance, and engineering
Outstanding written and verbal communications across clinicians, coders, engineers, and executive audiences
Must have an active and unrestricted US RN license (or equivalent clinical licensure)
BSN essential

Nice To Haves

Delivered AI or automation projects that deliver measurable undeniable impact
Thrived in the beautiful chaos of a high-growth startup
Direct prior experience inside health-plan or health-system revenue cycle operations (coding, billing, denials/appeals, CDI)
Certified Revenue Cycle Representative (CRCR), CCS, CPC, or CDI credential (CCDS/CDIP)
Background in clinical informatics, applied AI/ML in RCM workflow, or digital health revenue integrity
Familiarity with Snowflake, Looker, Tableau, Epic/Cerner billing modules, or comparable tooling
Experience preparing for or maintaining URAC/NCQA/HITRUST accreditations
MSN, MHA, MBA or MPH strongly preferred

Responsibilities

Own end-to-end clinical revenue cycle quality across all Penguin AI agents (Intake, Intelligent Queuing, Clinical Review, Appeals, PolicyVault™, HCC engine): documentation integrity, coding accuracy, sampling, and remediation
Build and run clinical documentation improvement (CDI) and coding-accuracy programs, including inter-rater reliability between AI and human coders/reviewers; detect drift, bias, and edge cases early
Operationalise CMS, payer, and coding standards (ICD-10, CPT, HCC/risk-adjustment, CMS-0057-F) with Compliance - make standards living processes, not binders
Own denials management: root-cause analysis, appeals strategy, CAPA, and closed-loop learning into model behavior, documentation prompts, and reviewer training
Stand up clinical training & competency frameworks for coding and CDI reviewers: onboarding, calibration, performance feedback
Turn revenue-cycle data into decisions: define clinical/financial metrics (clean claim rate, denial rate, risk-adjustment accuracy), partner with Data/Engineering to instrument Snowflake, and deliver dashboards and customer reports clinicians trust
Produce customer-facing RCM performance reporting (revenue integrity scorecards, quarterly business reviews) and surface risk-adjustment / reimbursement optimisation insights from HCC and coding activity
Be the clinical RCM partner across Product, Engineering, Customer Success, Finance, and the CMO; represent Penguin AI in customer and payer/regulator forums and conference presentations