Exactrx Applied AI Engineer Brentwood, TN · Remote · Full time Company website

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We're fixing one of the most broken and costly parts of the US healthcare system: medical billing.

Healthcare providers spend over $250B each year on administrative overhead just to get paid by insurance. Billing is expensive because it's hard: 100x harder than processing a credit card payment, with rules that differ for every insurance company. Most of it still runs on teams of people tracking those rules by hand, with little or no software to help. We're rethinking medical billing from the ground up, with AI agents and data science that automate this complexity so providers get paid faster and for far less. Our agents log into the systems our customers already use, then code, prepare, and submit their insurance claims, and we're accountable for getting them paid. We focus on surgery, the most expensive specialty to bill for.

We're backed by Overline, Tech Square Ventures, and Northwestern Medicine + incredible doctors that sit on the boards of the groups we sell to. We've all had a claim denied or watched someone we love fight one. We're helping our customers expand access to care by removing financial barriers, and we're excited to learn more about you!

ABOUT THE ROLE

As our Applied AI Engineer, you'll own the intelligence behind every claim Exactrx submits: the agents that code encounters, the payer logic that catches problems before submission, and the analysis that shows customers what changed. You'll report to our CTO + Head of AI, and work daily with our service delivery team, whose coders review the cases our AI agents can't yet handle.

You'll own whether our agents work in production, from framing the problem through evaluation, deployment, and the failures that make the next version better. Within 90 days, you'll own autocoding, payer logic, and analytics. You'll be one of our first engineering hires outside our leadership team, so we need a self-starter who  takes ownership, drives execution, and works closely with leadership to align on priorities and key decisions.

WHAT YOU'LL DO

• Build and improve LLM-driven agents that read clinical documentation and assign CPT, ICD-10, and modifier codes.
• Turn payer rules and published policies into claims checks that run before submission, and grow our claim rules library as new denials appear.
• Build evaluation loops from coder feedback, remittance data, and production traces to measure accuracy, catch regressions, and choose between prompting, retrieval, rules, and fine-tuning.
• Analyze claims data for new customers to determine drivers of AR days and denials in dollars, and build report cards for our sales team.
• Track performance after go-live.

WHAT WE'RE LOOKING FOR

• 3-5 years in software engineering, ML engineering, or applied AI, including at least 1 year shipping AI systems to production users.
• Strong Python background, and experience building LLM applications, agents, retrieval, or structured extraction.
• Experience designing evaluations and benchmarks for AI systems.
• Comfort with PHI under HIPAA controls.
• The ability to explain an analysis to a non-technical customer and defend the numbers.
• Nice to have: medical coding knowledge or a CPC, revenue cycle or payer experience, HL7, FHIR, or EDI experience, web development experience, and early-stage startup experience. Experience with messy real-world data such as 837 and 835 claims files and clinical notes.

Exactrx is an equal opportunity employer. We don't discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected characteristic. If you need accommodation during the application process, let us know. Background checks are administered in accordance with applicable law.