Clinical Intelligence Lead

About the role

As Clinical Intelligence Lead, you'll be the go-to expert on coding and medical policy at Hike. This role is for someone who deeply understands what diagnoses support what claims, which L-codes apply, where payers differ from Medicare, and what documentation is needed to prevent or resolve denials. Just as important, you'll turn that knowledge into clear, structured logic our systems can actually use. We're looking for someone who combines subject-matter depth with the ability to build repeatable, scalable processes.

Responsibilities

• Own the coding intelligence layer: for each HCPCS code block, define what diagnosis codes qualify, what documentation is required, and how to identify gaps.
• Translate clinical knowledge into structured agent guides - precise, field-level workflow specifications, not spreadsheets.
• Identify coding opportunities and documentation deficiencies across intake queues, and define the rules that fix them.
• Build and maintain the medical policy library: LCD/NCD coverage, CMS Required PA List changes, payer-specific deviations (UHC, Aetna, Cigna), and evidence-based updates as policies evolve.
• Partner with the Protocol Specialist and Compliance Specialist to ensure agent guides reference up-to-date coverage criteria.
• Review HITL team outputs for coding accuracy, and train new specialists on coding logic.
• Stay current with CMS policy changes - new codes, revised LCDs, PA list additions - and propagate them into agent guides within defined SLAs.

Requirements

• 5+ years in DMEPOS coding, with deep expertise in O&P (L-codes: AFOs, KAFOs, prosthetics) and diabetic footwear (A5500 series).
• Direct experience at a large DMEPOS company, O&P practice, or RCM firm.
• Working knowledge of CMS LCDs (L33686, L29702), Policy Articles, and the CMS Required Prior Authorization List.
• Ability to write precise, structured documentation that engineers can implement.
• Experience communicating with physicians about documentation insufficiencies, and with billers about claim adjudication.
• Comfortable in a fast-moving, early-stage environment where you build systems, not just use them.
• Why This Role
• This role has outsized impact. The quality and speed of your work directly influence how quickly - and how confidently - we can expand into new device categories.
• Location United States (remote OK; in-person preferred for first 90 days) Compensation 1.2× your current market rate. Competitive equity. Full benefits. Reports To Amit Bhanti, Head, Center of Excellence

Benefits

Additional Information

1. Clinical Intelligence Lead Center of Excellence - Medical Policy & Coding - United States (Remote OK; in-person preferred first 90 days) - Full-time Suggested salary range (confirm): $170,000-$250,000 + 1.2× market - competitive equity - full benefits About Hike Medical Hike Medical is an AI-run operator for prescribed medical devices (DMEPOS). We run the entire episode of care from fax intake to paid claim - using AI agents for the administrative workflow, our clinical platform for evaluation and documentation, and our factory (SoleForge) for device fabrication. Our three products - Hike AI Agents, Hike Clinical, and SoleForge - own the full episode of device care. We have grown from $2M to a $15.6M run rate on diabetic shoes and inserts alone, and we are now expanding into AFOs, prefab devices, and bracing. This is a pivotal moment to join. About the Center of Excellence The Center of Excellence is the intelligence engine of Hike. It owns the clinical and coding knowledge that powers every AI agent - producing agent guides per code block, setting evaluation standards, informing all compliance policies, and managing the human-in-the-loop team. CoE roles are the highest-leverage positions in the company: the documents and workflows you build determine how fast we expand into new device categories.

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