Machinify
Chief Medical Officer
Machinify is seeking a physician executive to serve as the clinical leader and executive partner to health plan clients. The CMO will drive trusted client relationships, guide payment integrity policy, and represent the clinical voice in product innovation.
Key Responsibilities
- • Build trusted partnerships with client Medical Directors, Payment Integrity executives, and senior payer stakeholders.
- • Partner with clients to validate results, demonstrate clinical credibility, and drive adoption of payment integrity solutions.
- • Collaborate with sales and customer success teams to support business development and long-term partnership growth.
- • Shape payer-specific payment policies for accurate enforcement in the Machinify system.
- • Provide evidence-based clinical and coding rationale during client audits, appeals and escalations.
- • Advise on complex reimbursement constructs across CMS, Medicaid, and commercial plans, including DRG classifications, OPPS/APC, NCCI, CPT/HCPCS, and modifier logic.
- • Maintain alignment with authoritative industry standards (CMS NCCI, AMA CPT, ICD-10 guidelines, AHIMA briefs).
- • Partner closely with operations, engineering, data science, product, and client services teams to ensure outputs are clinically sound.
- • Mentor internal clinicians and guide clinical playbooks and escalation protocols.
- • Represent the clinical perspective in product roadmap and innovation initiatives.
- • Advance clinical content innovation to ensure defensibility, scalability, and impact.
- • Shape the platform to move beyond identifying payment errors to diagnosing root causes and enabling systemic improvements.
Required
- • MD or DO with active license.
- • 10+ years in payment integrity, reimbursement operations, or claims auditing. Expertise across inpatient, outpatient, and professional claims (DRG, APCs, CPT/HCPCS, modifier logic).
- • Strong knowledge of CMS, Medicare, Medicaid, and commercial payer adjudication rules.
- • Proven executive-level client engagement experience.
- • Demonstrated leadership and ability to translate clinical insights into strategy.
Preferred
- • Experience with pharmacy claims, PBM workflows, or claims editing platforms (ClaimCheck, CES, Lyric).
- • Familiarity with AI/NLP or automation-driven audit workflows.
- • Advanced degree (MBA, MPH, MHA).
Company Overview
Industry: Healthcare Technology
Company Size: 500-1,000 employees
Founded: 2015
Headquarters: San Francisco, CA
Company Links
Key Contacts
Contact information not available
About the Company
Leading healthcare technology company focused on improving patient outcomes through innovative digital solutions. We're transforming the way healthcare is delivered with cutting-edge technology and data-driven insights. Our platform serves over 10,000 healthcare professionals and has processed millions of patient interactions.
Recent News & Updates
Series B
Raised $50M Series B funding - Jan 2024
Award
Named "Best Healthcare Startup" by TechCrunch - Dec 2023
Growth
Expanded to 5 new states - Nov 2023
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
About The Role
We are seeking a physician executive to serve as the clinical leader and executive partner to our health plan clients. Reporting to the CEO, the CMO will drive trusted client relationships, guide payment integrity policy, and represent the clinical voice in product innovation. This role emphasizes executive engagement and strategic influence, supported by a strong internal team managing day-to-day operations.
Key Responsibilities
Executive Client Engagement & Strategic Leadership
Machinify is committed to hiring talented and qualified individuals with diverse backgrounds for all of its positions. Machinify believes that the gathering and celebration of unique backgrounds, qualities, and cultures enriches the workplace.
See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/
About The Role
We are seeking a physician executive to serve as the clinical leader and executive partner to our health plan clients. Reporting to the CEO, the CMO will drive trusted client relationships, guide payment integrity policy, and represent the clinical voice in product innovation. This role emphasizes executive engagement and strategic influence, supported by a strong internal team managing day-to-day operations.
Key Responsibilities
Executive Client Engagement & Strategic Leadership
- Build trusted partnerships with client Medical Directors, Payment Integrity executives, and senior payer stakeholders.
- Partner with clients to validate results, demonstrate clinical credibility, and drive adoption of payment integrity solutions.
- Collaborate with sales and customer success teams to support business development and long-term partnership growth.
- Shape payer-specific payment policies for accurate enforcement in the Machinify system.
- Provide evidence-based clinical and coding rationale during client audits, appeals and escalations.
- Advise on complex reimbursement constructs across CMS, Medicaid, and commercial plans, including DRG classifications, OPPS/APC, NCCI, CPT/HCPCS, and modifier logic.
- Maintain alignment with authoritative industry standards (CMS NCCI, AMA CPT, ICD-10 guidelines, AHIMA briefs).
- Partner closely with operations, engineering, data science, product, and client services teams to ensure outputs are clinically sound.
- Mentor internal clinicians and guide clinical playbooks and escalation protocols.
- Represent the clinical perspective in product roadmap and innovation initiatives.
- Advance clinical content innovation to ensure defensibility, scalability, and impact.
- Shape the platform to move beyond identifying payment errors to diagnosing root causes and enabling systemic improvements.
- MD or DO with active license.
- 10+ years in payment integrity, reimbursement operations, or claims auditing. Expertise across inpatient, outpatient, and professional claims (DRG, APCs, CPT/HCPCS, modifier logic).
- Strong knowledge of CMS, Medicare, Medicaid, and commercial payer adjudication rules.
- Proven executive-level client engagement experience.
- Demonstrated leadership and ability to translate clinical insights into strategy.
- Experience with pharmacy claims, PBM workflows, or claims editing platforms (ClaimCheck, CES, Lyric).
- Familiarity with AI/NLP or automation-driven audit workflows.
- Advanced degree (MBA, MPH, MHA).
Machinify is committed to hiring talented and qualified individuals with diverse backgrounds for all of its positions. Machinify believes that the gathering and celebration of unique backgrounds, qualities, and cultures enriches the workplace.
See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/
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