AI Engineer for Health Tech Startup

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We are looking for an experienced AI Engineer to design and develop an AI-driven software solution that automates and streamlines the authorization process between health insurance companies and healthcare providers for mental health and substance use treatment. This platform will leverage machine learning, natural language processing (NLP), and predictive analytics to enhance efficiency, reduce administrative burden, and improve approval rates. Key Responsibilities: Develop AI models to analyze clinical documentation and predict insurance authorization outcomes. Implement NLP algorithms to extract and process key information from provider-submitted treatment requests. Automate prior authorization workflows by aligning AI predictions with insurer medical necessity criteria (DSM-5, ASAM, ICD-10). Ensure compliance with HIPAA and other healthcare regulations while handling sensitive patient data. Integrate AI-driven decision support tools to assist providers in optimizing submissions for higher approval rates. Develop API integrations for EHR systems, insurer portals, and provider platforms. Build a cloud-based, user-friendly interface for healthcare providers and insurance representatives. Train AI models using real-world claims and authorization data to enhance accuracy and efficiency. Required Qualifications: Proven experience in AI/ML development, particularly in healthcare technology. Expertise in natural language processing (NLP), deep learning, and predictive modeling. Strong background in Python, TensorFlow, PyTorch, or other AI frameworks. Experience with healthcare data (EHR/EMR systems, medical claims, clinical documentation). Knowledge of FHIR, HL7, HIPAA compliance, and secure data handling. Familiarity with health insurance processes, including prior authorization and claims management. Ability to deploy AI models in a scalable cloud-based application (AWS, Azure, or Google Cloud). Preferred Skills: Experience with electronic health record (EHR) system integration. Understanding of medical necessity guidelines, ASAM criteria, and behavioral health regulations. Background in healthcare informatics, insurance claims automation, or provider-insurer interactions. Project Scope: The AI software will: ✅ Automate clinical documentation analysis to extract key medical necessity information. ✅ Predict authorization outcomes based on insurer-specific criteria. ✅ Reduce manual workload for providers and insurance representatives. ✅ Enhance transparency between insurers and behavioral health providers. ✅ Improve access to care by accelerating approval processes for necessary treatment. Deliverables: Fully functional AI-powered authorization system with a predictive analytics engine. Web-based or cloud-hosted platform for provider-insurer interactions. API for seamless integration with existing EHRs and insurance portals. Detailed documentation and training materials for end users.

Keyword: Web Development

Full-Stack Development Artificial Intelligence Machine Learning