Clinical Subject Matter Expert

The role

You will own the clinical judgment behind position statements for facility claims. You will work with Product and Engineering to define clinical standards, annotate data to train AI models, and build evaluation criteria.

What you will do

• Review position statements drafted by the model for facility claims
• Define clinical standards for describing care and defending offers
• Label and annotate statements to train the model
• Design and run evaluations to measure statement quality
• Define clinical and billing context requirements for each claim
• Partner with Product and Engineering as the clinical voice
• Incorporate feedback from reviewers and operations into product improvements
• Help the team understand facility side coding, billing, and reimbursement nuances

Required qualifications

• Clinical background, most often nursing
• 5+ years of experience in clinical documentation, denials, or appeals
• Hands-on experience writing or reviewing appeals, denial responses, or clinical arguments
• Working knowledge of facility billing, coding, and reimbursement
• Experience giving structured, consistent feedback on written work
• Ability to turn clinical judgment into clear written requirements and criteria
• Comfort working inside a product team
• Authorized to work in the United States without current or future employer sponsorship

Nice to have

• Experience in revenue integrity, utilization review, or clinical documentation improvement for hospitals or health systems
• Familiarity with the No Surprises Act or Independent Dispute Resolution
• Experience working with 835/837 claims data or evaluating AI-generated content

Benefits

• Competitive compensation, including equity
• Full health, dental, and vision coverage
• Retirement savings plan through 401(k)
• Flexible time off
• Opportunities for company-wide connection and events

Before you apply

• Candidates must be authorized to work in the United States without current or future employer sponsorship
• Employment is contingent upon successful completion of applicable background checks

About the company

Pivotal Health is a technology platform that helps healthcare providers get paid fairly through an AI-driven platform that simplifies reimbursement workflows.