Jobs at Alaffia Health

Reviews high-dollar inpatient facility bills, medical records, and automated audit results for coding, billing, documentation, and payment accuracy. Audits UB-04s, revenue codes, and itemized charges against clinical records and national or payer-specific guidelines. Documents claim inconsistencies, confirms services were rendered, researches coding accuracy, and helps train automated claims-auditing systems. Requires inpatient coding or auditing experience, a coding certification, and at least three years of bill review experience.

Alaffia’s Talent Pool invites candidates interested in future opportunities at its NYC-based healthcare AI startup. Applicants can submit their information and a cover letter describing their motivation and preferred business areas or roles. The talent team will retain profiles and proactively contact candidates when suitable positions become available. The company develops AI-powered copilots and agents to reduce healthcare administrative burden, billing waste, and costs.

Manage the end-to-end payment integrity audit lifecycle, including provider documentation requests, follow-ups, inbox triage, audit finding letters, case tracking, and communication logging. Maintain accurate, compliant workflows, improve SOPs, coordinate with clinical auditors, appeal teams, and product teams, and provide professional, empathetic provider support. Use Microsoft Office and Google Workspace tools, including spreadsheets, formulas, filters, and pivot tables, for tracking and reporting.

Perform inpatient DRG validation audits and clinical reviews of medical records and claims to verify diagnoses, procedures, CCs/MCCs, sequencing, and discharge status. Document defensible findings, ensure compliance with ICD-10 and DRG grouper rules, support QA, and collaborate with operations, product, and engineering to improve audit logic and automation.

The Clinical Payment Integrity Analyst reviews medical claims and patient records, audits for coding violations, and ensures compliance with healthcare payment guidelines.

Lead strategy, growth, and delivery of clinical payment integrity offerings for health plan clients. Build and mentor a high-performing client-facing team, sponsor strategic accounts, partner with Product/Engineering/Sales to shape AI-enabled claims solutions, drive revenue expansion, ensure operational excellence, and represent the company at industry forums.

Review and investigate provider disputes for high-dollar facility claims and itemized bills. Analyze UB-04s, itemized bills, medical records, and audit findings to determine whether Payment Integrity findings should be upheld, modified, or overturned. Apply coding and reimbursement guidelines (CPT, ICD-10, HCPCS, DRGs, APCs), document defensible decisions, manage a high-volume queue, and collaborate with Payment Integrity teams while ensuring PHI/HIPAA compliance.

Lead strategy, performance, and scaling of Payment Integrity review programs (IBR, medical record review, DRG validation). Manage managers, set quality/KPI targets, own audit governance, SOPs, capacity planning, client reporting/escalations, and partner with Product/Engineering on AI-assisted workflows.

Full-cycle recruiter for Payment Integrity and Managed Services hiring: manage multiple high-volume requisitions, source and screen candidates, coordinate interviews, maintain ATS records, build pipelines, advise hiring managers, and support recruiting events.