[Remote] Clinical Intelligence Lead

Note: The job is a remote job and is open to candidates in USA. Hike Medical is an AI-run operator for prescribed medical devices, focusing on enhancing the episode of care with innovative solutions. The Clinical Intelligence Lead will be the expert on coding and medical policy, responsible for defining coding intelligence, translating clinical knowledge into structured workflows, and maintaining a comprehensive medical policy library.ResponsibilitiesOwn the coding intelligence layer: for each HCPCS code block, define what diagnosis codes qualify, what documentation is required, and how to identify gapsTranslate clinical knowledge into structured agent guides — precise, field-level workflow specifications, not spreadsheetsIdentify coding opportunities and documentation deficiencies across intake queues, and define the rules that fix themBuild and maintain the medical policy library: LCD/NCD coverage, CMS Required PA List changes, payer-specific deviations (UHC, Aetna, Cigna), and evidence-based updates as policies evolvePartner with the Protocol Specialist and Compliance Specialist to ensure agent guides reference up-to-date coverage criteriaReview HITL team outputs for coding accuracy, and train new specialists on coding logicStay current with CMS policy changes — new codes, revised LCDs, PA list additions — and propagate them into agent guides within defined SLAsSkills5+ years in DMEPOS coding, with deep expertise in O&P (L-codes: AFOs, KAFOs, prosthetics) and diabetic footwear (A5500 series)Direct experience at a large DMEPOS company, O&P practice, or RCM firmWorking knowledge of CMS LCDs (L33686, L29702), Policy Articles, and the CMS Required Prior Authorization ListAbility to write precise, structured documentation that engineers can implementExperience communicating with physicians about documentation insufficiencies, and with billers about claim adjudicationComfortable in a fast-moving, early-stage environment where you build systems, not just use themBenefitsCompetitive equityFull benefitsCompany OverviewBuilding the world's vertically integrated, AI-native, DME provider. It was founded in 2023, and is headquartered in Boston, Massachusetts, USA, with a workforce of 51-200 employees. Its website is https://www.hikemedical.com/.Company H1B SponsorshipHike Medical has a track record of offering H1B sponsorships, with 2 in 2025. Please note that this does not guarantee sponsorship for this specific role.