Artificial Intelligence Engineer - Medical Billing

Role Overview: We are hiring a Senior AI Engineer to build and scale an AI-powered Denial Prediction platform that proactively identifies, prevents, and explains claim denials across the RCM lifecycle. This role focuses on combining AI-assisted software development (Copilot, LLMs) with predictive modeling and healthcare data engineering to drive measurable reductions in denial rates. You will architect systems that move beyond rule-based logic into intelligent, learning-driven workflows that integrate deeply with claims, coding, and payer behavior.

Key Responsibilities

• Design and develop AI-driven denial prediction systems using structured (837/835, EHR) and unstructured healthcare data.

• Leverage AI-assisted development tools (GitHub Copilot, LLM APIs) to accelerate feature development and model deployment.

• Build predictive models to identify denial risk pre-submission (eligibility issues, coding errors, payer-specific edits, documentation gaps).

• Develop explainable AI outputs that clearly indicate why a claim is likely to be denied and recommend corrective actions.

• Architect real-time and batch data pipelines for claims ingestion, feature engineering, and model scoring.

• Integrate denial prediction engines into RCM workflows (coding, billing, claim scrubbing, edits).

• Continuously improve model performance using denial feedback loops (835 remits, appeal outcomes).

• Ensure HIPAA compliance, auditability, and traceability of AI-driven decisions.

• Establish validation frameworks for AI-generated code and model outputs.

• Collaborate closely with RCM SMEs to encode payer rules, denial patterns, and workflow nuances into models.

Required Qualifications

• 5–10 years in software engineering, with strong backend and data engineering experience.

• Hands-on experience using AI-assisted coding tools (GitHub Copilot, ChatGPT, etc.) in production environments.

• Experience building or deploying machine learning models (classification, anomaly detection, or risk scoring).

• Strong proficiency in Python (preferred), with experience in ML libraries (scikit-learn, TensorFlow, PyTorch, or similar).

• Experience working with healthcare data formats (X12 837/835, HL7, FHIR).

• Solid understanding of RCM processes especially claims submission and denial management.

• Ability to produce models (APIs, pipelines, monitoring, retraining workflows).

Preferred Qualifications

• Experience building denial prediction, claim scrubbing, or revenue integrity solutions.

• Familiarity with payer rules engines and clearinghouse workflows.

• Experience with explainable AI techniques (feature importance, SHAP, rule extraction).

• Exposure to LLM-based reasoning for documentation validation or coding assistance.

• Experience integrating with EHRs (Epic, Cerner) or billing systems.

• Understanding of HCC coding, medical necessity rules, and prior authorization impact on denials.