Head of RCM Systems & AI Compliance at Hike Medical Co

Boston, Massachusetts, United States -

Full Time

Start Date

Immediate

Expiry Date

05 Apr, 26

Salary

0.0

Posted On

05 Jan, 26

Experience

10 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

RCM, Compliance, DME, O&P, Medicare, Eligibility Verification, Prior Authorization, Documentation Standards, Claims Submission, Denials, Medical Necessity, Systems Thinking, AI Workflows, Human-in-the-Loop, Quality Metrics, Team Building

Industry

technology;Information and Internet

Description

About Hike Medical Hike Medical is reinventing musculoskeletal care, starting with feet. Our proprietary AI-vision platform turns a 30 second web based (yes, no sensors) foot scan into precision engineered, 3D-printed insoles that prevent pain before it starts. We're already protecting on-their-feet workforces at Fortune 50 leaders, major health systems, and middle America manufacturers. Fresh off a stealthy round with top tier VCs, we run a fast, no BS, execution first culture out of Boston’s Seaport as we sprint toward $100M ARR and standing with 10M Americans as they step into their shoes daily. First and only PDAC approved 3D printed custom insole in the world 🌎 3 Proprietary AI models that power the experience Two products: One is focused on serving employers & health plans, and the other enables clinics to deliver foot care at a fraction of the cost - creating a virtuous cycle of clinician labelled data. Expanded care access to over 100,000 Americans to date 10x'd revenue from 2023 to 2024, and on track to do the same in 2025. Profitable month-over-month. Non-Negotiable Expertise This role is for someone with deep, hands-on RCM and compliance expertise in DME and/or O&P. You must have real operating experience with Medicare-heavy workflows and a working understanding of how rules are applied in practice—not just how they are written. You will be responsible for encoding this expertise into the rules, validation logic, and human-in-the-loop systems that govern AI agents operating in production. If you have not personally dealt with eligibility checks, prior authorizations, documentation requirements, medical necessity reviews, claims submission, denials, and payer follow-ups in DME or O&P, this role will not be a fit. The Mission We are building AI agents that run core back-office workflows for O&P and DME providers. This role owns the compliance logic and human-in-the-loop (HITL) architecture that makes those agents safe, auditable, and trusted by large operators. You will define how: Regulatory rules are translated into systems Humans intervene in AI workflows Edge cases are identified, resolved, and learned from Compliance risk is actively managed at scale This is a foundational role with end-to-end ownership of HITL systems and compliance rules, and a clear mandate to build and lead this function as the platform scales. What You’ll Own RCM Rules & Compliance Systems Own and define the rulesets governing AI behavior across: Eligibility & benefits verification Prior authorization Referrals and documentation requirements Medical necessity validation Claims submission, denials, and appeals Translate payer and Medicare requirements into: Structured rules Decision trees Validation logic Agent instructions Identify and encode real-world exceptions, workarounds, and edge cases Continuously audit AI workflows against regulatory and payer requirements Human-in-the-Loop Architecture Design HITL workflows that sit directly inside AI-driven processes Define escalation thresholds based on confidence, risk, and compliance impact Perform hands-on review and correction of AI output to: Validate accuracy Train and refine systems Identify failure modes Establish quality metrics tied to regulatory exposure, not vanity accuracy Engineering & Product Partnership Work directly with engineering to: Implement deterministic rules alongside AI systems Design feedback loops between human review and agent behavior Build tools that support rapid iteration and auditability Serve as the domain authority for how AI should behave inside regulated workflows Customer & Industry Collaboration Partner directly with customer RCM and compliance teams to: Understand their existing workflows Surface edge cases and payer-specific nuances Coordinate on escalations and compliance interpretation Stay deeply embedded in O&P and DME operational reality Team Building & Scale Design and build the HITL function from first principles Hire, train, and lead HITL specialists as volume and complexity increase Define operating procedures, escalation models, and performance standards Build systems that reduce human involvement over time while increasing reliability What You Bring Significant hands-on experience in DME and/or O&P revenue cycle management Deep working knowledge of: Medicare eligibility and benefits Prior authorization workflows Referrals and documentation standards Medical necessity logic Claims submission, denials, and appeals Demonstrated ability to interpret and apply complex rules in ambiguous situations Strong systems thinking and comfort working with engineers Willingness to operate as a senior IC while building toward a leadership role Builder mindset with high ownership and accountability Startup experience is not required. Owning critical systems is. Why This Role Matters You are defining how AI operates safely in regulated healthcare Your decisions directly affect production AI behavior and compliance risk You will build the foundation for AI-driven back-office operations at industry-leading scale Clear path to leading a core function as StepZero grows

Responsibilities

The role involves owning and defining the rulesets governing AI behavior in revenue cycle management and compliance systems. It also includes designing human-in-the-loop workflows and ensuring compliance with regulatory requirements.