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.
Responsibilities
- Own the coding intelligence layer: for each HCPCS code block, define what diagnosis codes qualify, what documentation is required, and how to identify gaps
- Translate clinical knowledge into structured agent guides — precise, field-level workflow specifications, not spreadsheets
- Identify coding opportunities and documentation deficiencies across intake queues, and define the rules that fix them
- Build 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 evolve
- Partner with the Protocol Specialist and Compliance Specialist to ensure agent guides reference up-to-date coverage criteria
- Review HITL team outputs for coding accuracy, and train new specialists on coding logic
- Stay current with CMS policy changes — new codes, revised LCDs, PA list additions — and propagate them into agent guides within defined SLAs
Skills
- 5+ 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 firm
- Working knowledge of CMS LCDs (L33686, L29702), Policy Articles, and the CMS Required Prior Authorization List
- Ability to write precise, structured documentation that engineers can implement
- Experience communicating with physicians about documentation insufficiencies, and with billers about claim adjudication
- Comfortable in a fast-moving, early-stage environment where you build systems, not just use them
Benefits
- Competitive equity
- Full benefits
Company Overview
Building 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 Sponsorship
Hike 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.