Job Description

Role Overview

We're seeking experienced

Utility Management Nurses

to support a client's healthcare product development by leveraging expertise in

insurance coding and hospital revenue management workflows

. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes.

Key Responsibilities

Insurance Coding & Revenue Cycle Alignment:

Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy.

Workflow Analysis:

Evaluate existing revenue management workflows and recommend improvements tailored to client's AI-driven documentation tools.

Clinical Data Interpretation:

Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies.

Policy Matching:

Assess coding accuracy against insurance guidelines and payer documentation requirements.

Product Development Collaboration:

Work closely with client's engineering and product teams to refine AI models that automate or assist with medical coding and documentation.

Compliance & Quality Assurance:

Ensure alignment with HIPAA, CMS, and payer-specific coding regulations.

Required Qualifications

Licensure:

Registered Nurse (RN) or equivalent clinical background.

Experience:

Minimum 3-5 years in

medical coding

,

clinical documentation improvement (CDI)

, or

revenue cycle management

.

Certifications:

CPC, CCS, or CRC certification preferred.

Domain Expertise:

Familiarity with

hospital billing systems

,

payer policy interpretation

, and

coding audit procedures

.

Analytical Skills:

Strong understanding of clinical documentation standards and payer logic.

Tech Savvy:

Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software.

Preferred Qualifications

Experience working within

hospital revenue integrity teams

or

insurance utilization management

. Exposure to

AI-powered healthcare documentation tools

or

automated coding systems

. Ability to identify and flag edge cases or policy exceptions in automated workflows. Strong collaboration skills with cross-functional (engineering, compliance, and data) teams.

Engagement Model

*

Contract / Part-time (Remote/In person)

-- Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus