Clinical Intelligence Lead

About the role

The Center of Excellence is the intelligence engine of Hike. It owns the clinical and coding knowledge that powers every AI agent, producing agent guides per code block, setting evaluation standards, informing all compliance policies, and managing the human-in-the-loop team.

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.

Requirements

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.

Qualifications

Master's degree in healthcare administration, public health, or related field.

Strong analytical skills and attention to detail.

Excellent communication and collaboration skills.

Skills

Deep understanding of DMEPOS coding, particularly O&P and diabetic footwear.

Experience working with CMS policy documents and guidelines.

Ability to translate complex clinical information into actionable coding and documentation strategies.

Benefits

Full benefits package including health insurance, retirement plans, and paid time off.

Pay

$160K - $230K based on experience and qualifications.

Schedule

Full-time position with remote work options initially, transitioning to in-person work after the first 90 days.