Clinical AI Specialist, RN - Medical Coding

Transform Healthcare With Us

At Qualified Health, we're redefining what's possible with Generative AI in healthcare. Our infrastructure provides the guardrails for safe AI governance, healthcare-specific agent creation, and real-time algorithm monitoring working alongside leading health systems to drive real change.

This is more than just a job. It's an opportunity to build the future of AI in healthcare, solve complex challenges, and make a lasting impact on patient care. If you're ambitious, innovative, and ready to move fast, we'd love to have you on board.

Join us in shaping the future of healthcare.

Job Summary

The Clinical AI Specialist, RN - Medical Coding is a unique role that combines clinical nursing expertise with medical coding knowledge to help build and refine Qualified Health's AI-powered revenue cycle management tools. You will bring your clinical and coding expertise to our Medical Coding product line, starting with Emergency Department coding and expanding into broader RCM applications.

In this role, you'll work closely with our product and engineering teams to validate clinical logic, stress-test edge cases, and ensure our AI tools produce accurate, compliant outputs. Your deep understanding of how clinical documentation translates into codes and how coding errors affect reimbursement and compliance will directly shape how our products work. You'll also stay current on coding guidelines and regulatory changes so our tools always reflect the latest standards.

This is not a traditional coding or nursing role. You'll be embedded in a fast-moving health tech team, using and evaluating AI tools daily, and your expertise will have an outsized impact on the quality and safety of products used across leading health systems. This role reports to Product Leadership and is ideal for someone who wants to apply their clinical and coding skills in a completely new way.

This is a full-time role, though we are open to discussing a part-time or contract arrangement to start for the right candidate.

Key Responsibilities

Clinical Coding Expertise & Product Development

• Provide expert input on E/M leveling, CPT and ICD-10 code selection, modifier usage, and documentation requirements specific to emergency medicine. You'll serve as the internal clinical and coding authority for Qualified Health's Medical Coding product line, with an initial focus on Emergency Department coding

• Review and stress-test business logic and AI-generated coding outputs against clinical documentation, ensuring accuracy, completeness, and compliance with CMS, AMA, and payer-specific guidelines

• Ensure clinical safety and functional accuracy of product releases before they reach customers

Guideline Management & Compliance

• Stay up to date on coding guidelines, CMS rules, LCD/NCD policies, and payer requirements that affect ED coding and broader RCM workflows, translating them into actionable product requirements and relevant internal documents

• Advise on compliance considerations as the product line expands into new RCM areas beyond ED coding

Cross-Functional Collaboration

• Partner with product managers, engineers, and data scientists to inform product design decisions with real-world coding expertise; helping the team understand the "why" of Medical Coding

• Create and review test cases, sample charts, and validation datasets to ensure comprehensive product testing

• Contribute to client-facing materials, training documentation, and product demos where clinical coding credibility is needed

Platform & AI Engagement

• Become a power user of Qualified Health's AI coding tools, developing deep familiarity with their capabilities and limitations

• Identify opportunities where AI can add more value in the coding and revenue cycle workflow

• Help define what "good" looks like for AI-assisted coding by establishing accuracy benchmarks and quality standards

Required Qualifications

• Active Registered Nurse (RN) license

• 3-7 years of experience in medical coding, clinical documentation improvement (CDI), or revenue cycle roles, with meaningful exposure to Emergency Department coding

• Strong working knowledge of CPT, ICD-10-CM/PCS, E/M leveling, HCPCS, CCI edits, and modifier application

• Familiarity with CMS guidelines, Medicare/Medicaid billing rules, and payer-specific requirements

• Comfort working with technology teams and translating clinical concepts into product requirements

• Ability to work independently and manage your own priorities in a fast-paced startup environment

Desired Qualifications

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar coding certification

• Direct experience with ED coding workflows, including facility and professional fee coding

• Experience with clinical decision-support tools, coding software, or health IT platforms

• Background in coding audits, denial management, or compliance review

• Regular user of generative AI tools (ChatGPT, Claude, or similar) with curiosity about how AI can improve healthcare operations

• Previous experience at a health tech company, healthcare startup, or coding/RCM vendor

Skills & Attributes

• Coding Precision: You catch what others miss. You understand the nuances of code selection, modifier usage, and documentation requirements, and you hold the product to the same standard.

• Clinical Translator: You can bridge the gap between clinical documentation, coding logic, and product engineering. You speak all three languages.

• Detail-Oriented: Meticulous in your review process. You think in edge cases and aren't satisfied until you've pressure-tested the logic thoroughly.

• Tech-Forward: Excited about AI and technology. You don't need to be an engineer, but you're genuinely curious about how AI works and eager to learn new tools.

• Self-Directed: You take ownership of your work and manage your time well. You don't need someone looking over your shoulder to deliver high-quality results.

• Collaborative: You enjoy working with product and engineering teams and can communicate your expertise clearly without talking down to non-clinical colleagues.

• Adaptable: Comfortable with ambiguity and changing priorities. You're joining a startup where the product is evolving quickly, and you see that as exciting, not stressful.

Travel Requirements

This role is remote-friendly. Occasional travel to Palo Alto for team collaboration and planning sessions may be required, estimated at less than 15%.

Why Join Qualified Health?

This is an opportunity to join a fast-growing company and a world-class team, that is poised to change the healthcare industry. We are a passionate, mission-driven team that is building a category-defining product. We are backed by premier investors and are looking for founding team members who are excited to do the best work of their careers.

Our employees are integral to achieving our goals so we are proud to offer competitive salaries with equity packages, robust medical/dental/vision insurance, flexible working hours, hybrid work options and an inclusive environment that fosters creativity and innovation.

Our Commitment to Diversity

Qualified Health is an equal opportunity employer. We believe that a diverse and inclusive workplace is essential to our success, and we are committed to building a team that reflects the world we live in. We encourage applications from all qualified individuals, regardless of race, color, religion, gender, sexual orientation, gender identity or expression, age, national origin, marital status, disability, or veteran status.

What We Offer

• Competitive startup salary and equity packages.

• Health, dental, and vision insurance.

• Flexible working hours and remote work options.

• An opportunity to be at the forefront of AI in healthcare, making substantial impacts on patient care and outcomes.