- Be the Operational “Truth Source” for the Platform
You will be accountable for validating that platform outputs make sense in the real world. This includes:
- Reviewing payer contracts, amendments, and fee schedules
- Interpreting real-world contract logic (lesser-of, modifiers, MCO products, effective dates)
- Reading raw 835 remits and identifying:
- Reimbursement issues vs legitimate adjustments
- Payer miss configuration vs provider error
- Systemic vs one-off issues
- Calling out false positives and explaining why something is not a true issue
If something looks “technically correct” but operationally wrong, you are expected to stop it.
- Own Synthetic Data Realism (Critical)
The platform will initially rely on synthetic data for development and validation. You will:
- Define what “realistic” synthetic data looks like: payer mix, CARC/RARC distributions, modifier usage
patterns, underpayment frequency and dollar impact
- Review synthetic data sets and flag unrealistic assumptions
- Guide engineers and vendors on correcting synthetic data generation logic
This role protects the credibility of everything we build.
- Be Deeply Embedded in Testing & Validation
You will be hands-on in:
- Reviewing detection outputs and classifying true vs false positives
- Validating confidence scores against operational reality
Effective – February 12, 2026
Credence Resource Management
v1.0
- Helping define “suggested next step” classifications (appeal, rebill, review, do not pursue)
- Testing against real customer data during pilot phases
Your feedback will directly shape detection logic, confidence thresholds, and future AI agent behavior. You are
effectively the human-in-the-loop backbone of the system.
- Act as the RCM Counterweight in Vendor Engagements
You will actively participate in vendor evaluations, technical reviews, and edge-case discussions. You will:
- Ask uncomfortable but necessary questions
- Spot hand-wavy answers around contracts or EDI
- Distinguish between “can build,” “has built,” and “is guessing”
This role is critical to holding vendors accountable and ensuring delivery meets operational standards.
- Help Carry the Long-Term Platform Vision Forward
While the MVP starts with underpayments, the platform is designed to evolve toward:
- Broader reimbursement correctness (denials, old AR, charge capture)
- Recommendation intelligence and outcome monitoring
- Selective automation with AI agents
- Contract renegotiation insights
You will help ensure core data models are reusable, intelligence is generalized, and we don’t hard-code short
term assumptions that block long-term evolution.
Experience & Domain Expertise
- 6-10+ years in health care RCM — revenue integrity, payer contracts, payment analysis, denials, or A/R
- Experience working with ambiguous or conflicting data
- Deep knowledge of payer contracts and fee schedules — percent of Medicare, lesser-of, MCO products,
modifier rules, effective dates
- Deep knowledge of the RCM data ecosystem — claims, remittances, fee schedules, industry
benchmarks, regulatory references, and how they connect
- Deep expertise in at least one RCM process area (appeals, denials, A/R follow-up, payment posting) —
you’ll help design how AI agents execute these work flows
Judgment & Mindset
- Strong judgment in gray areas where contracts, data, and payer behavior don’t line up
- Willingness to challenge assumptions — including those from engineers and vendors
- Comfortable saying “this would never happen in production”
- Builder mentality: you like shaping systems, not just running reports
Technical Comfort (Not a Data Scientist)
- SQL proficiency — ability to query data, validate outputs, build test cases
- Advanced Excel — pivot tables, VLOOKUP/INDEX-MATCH, large data set manipulation
- Comfortable working with raw data (CSV, JSON, EDI extracts)
- Able to explain domain logic clearly to engineers — you don’t need to code, but you must understand
how logic translates into systems
Preferred (Nice to Have)
- Experience with lab billing (CLFS) or physician billing (PFS) — ideally both
- Background in underpayment recovery, contract audits, or payer disputes
- Familiarity with Medicare fee schedules and locality adjustments (GPCI)
- Experience with data warehouses (Snowflake, Redshift, BigQuery)
- Prior experience in a startup or product development environment
Kindly Note: At Credence, we uphold the highest standards of integrity in our recruitment process. We
do not charge any fees at any stage of the hiring process, and we strictly prohibit any third parties,
vendors, or individuals from soliciting money in exchange for job opportunities at Credence.
If you are approached by anyone requesting payment or offering you a position at Credence in exchange
for money, do not engage with them. Such actions are fraudulent and not authorized by Credence.
Please report any such incidents immediately to our official HR team at [email protected]
Your safety and trust are important to us. Thank you for helping us maintain a fair and transparent hiring
environment.
