Talentgigs
Website:
talentgigs.in
Job details:
Job Title: AI with Dot net– Denial Prediction
Experience: 4–9 Years
Company: TalentGigs
Domain: Healthcare / Revenue Cycle Management (RCM)
Location: Chennai
Job Title: Senior AI Engineer – Denial Prediction (RCM AI Platform)
Role Overview: We are hiring a Senior AI Engineer to build and scale an AI-powered Denial Prediction platform that proactively identifies, prevents, and explains claim denials across the RCM lifecycle. This role focuses on combining AI-assisted software development (Copilot, LLMs) with predictive modeling and healthcare data engineering to drive measurable reductions in denial rates.
You will architect systems that move beyond rule-based logic into intelligent, learning-driven workflows that integrate deeply with claims, coding, and payer behavior.
Key Responsibilities
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Design and develop AI-driven denial prediction systems using structured (837/835, EHR) and unstructured healthcare data.
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Leverage AI-assisted development tools (GitHub Copilot, LLM APIs) to accelerate feature development and model deployment.
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Build predictive models to identify denial risk pre-submission (eligibility issues, coding errors, payer-specific edits, documentation gaps).
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Develop explainable AI outputs that clearly indicate why a claim is likely to be denied and recommend corrective actions.
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Architect real-time and batch data pipelines for claims ingestion, feature engineering, and model scoring.
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Integrate denial prediction engines into RCM workflows (coding, billing, claim scrubbing, edits).
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Continuously improve model performance using denial feedback loops (835 remits, appeal outcomes).
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Ensure HIPAA compliance, auditability, and traceability of AI-driven decisions.
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Establish validation frameworks for AI-generated code and model outputs.
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Collaborate closely with RCM SMEs to encode payer rules, denial patterns, and workflow nuances into models.
Required Qualifications
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5–10 years in software engineering, with strong backend and data engineering experience.
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Hands-on experience using AI-assisted coding tools (GitHub Copilot, ChatGPT, etc.) in production environments.
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Experience building or deploying machine learning models (classification, anomaly detection, or risk scoring).
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Strong proficiency in Python (preferred), with experience in ML libraries (scikit-learn, TensorFlow, PyTorch, or similar).
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Experience working with healthcare data formats (X12 837/835, HL7, FHIR).
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Solid understanding of RCM processes especially claims submission and denial management.
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Ability to produce models (APIs, pipelines, monitoring, retraining workflows).
Preferred Qualifications
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Experience building denial prediction, claim scrubbing, or revenue integrity solutions.
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Familiarity with payer rules engines and clearinghouse workflows.
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Experience with explainable AI techniques (feature importance, SHAP, rule extraction).
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Exposure to LLM-based reasoning for documentation validation or coding assistance.
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Experience integrating with EHRs (Epic, Cerner) or billing systems.
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Understanding of HCC coding, medical necessity rules, and prior authorization impact on denials.
Key Traits for Success
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Strong problem framing: can translate denial patterns into model-ready features.
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Balances speed (AI-assisted development) with precision (healthcare compliance).
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Obsessed with measurable outcomes (denial reduction %, AR improvement).
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High ownership in building production-grade, reliable AI systems.
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Thinks in feedback loops and continuous model improvement.
What Success Looks Like
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Reduction in denial rates pre-submission.
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Improved clean claim rate and first-pass acceptance.
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Actionable insights for coders and billers embedded in workflows.
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Scalable AI system that adapts to payer-specific behavior over time.
Work closely with GTM and product to translate innovation into enterprise adoption.
Click on Apply to know more.