Clinical Payment Integrity Analyst (RN CPC)

Every year U.S. health plans lose billions to improper payments and administrative waste. That wasted spending ultimately trickles down across the healthcare ecosystem driving up costs for plans providers and patients alike. We’re here to change that paradigm.

Alaffia is a new kind of claims operations partner for health plans. Using expert clinicians and transparent AI we deliver deeper insights smarter automation and consistently better outcomes across the entire lifecycle of claims. With Alaffia health plans can cut wasted spending more effectively than ever — and provide their members the most affordable care.

We’re a high-growth venture-backed Series B healthtech startup based in NYC and are actively scaling our company. Join us in helping to build a healthcare system that works better for everyone.

*This position requires current authorization to work in the United States. Unfortunately we are not in a position to sponsor work visas at this time.

We are looking for a Medical Bill reviewer to join our team! Do you have experience reviewing claim forms and auditing provider documentation? Then this position is for you! You will work alongside our team to empower our clients with technology that will modernize medical claim auditing.

You will be responsible for reviewing and analyzing medical claims patient medical records and automatic claim audit results to help train our machines to deliver automated audit results. You will be performing high-dollar facility bill reviews. Your role will be integral to your engineering teams and will help inform decisions that will shape the future of healthcare we aim to see.

• Combing through UB-04/IB's for any potential coding/billing violations

• Comparing the IB/UB-04 against the medical record to validate charges and assess the quality of the medical record

• Auditing revenue codes against clinical documentation

• Confirmation of services billed were rendered

• Clear documentation of inconsistencies with claims billed vs health plan payments

• Confirming automatic audit results based on national and payer-specific guidelines

Who You Are

• Facility Inpatient Coding/Auditing Experience (Required)

• At least one of the following certifications is mandatory (CPC/CIC/CRC/CPMA)

• Clinical license (RN) required

• Experience working at an insurance company (preferred) 

• Experience performing audits on line item charges on Itemized Bills

• Deep background in medical billing coding or auditing of insurance claims and medical records

• Experience working with national guidelines such as CPT codes ICD-9/10 HCPCS codes POS codes DRGs APCs and other code sets and the translation of written clinical information into auditable clinical content.

• Knowledge of hospital-based billing/coding

• Knowledge of PHI/HIPAA compliance and standards

• Ability to research and verify claim coding accuracy

• Minimum of 3 years of auditing/bill review experience

Alaffia was born out of our founders’ personal connection to the inefficiency of the U.S. healthcare system. We are deeply mission-driven with an abiding belief that technology can help create a better future for everyone — and we’re looking for others who share our passion for change to join the team.

• Competitive compensation package

• Medical Dental and Vision benefits

• Flexible paid vacation policy

• Work in a flat organizational structure — direct access to Leadership

What We Do

Every year U.S. health plans lose billions to improper payments and administrative waste. That wasted spending ultimately trickles down across the healthcare ecosystem driving up costs for plans providers and patients alike. We’re here to change that paradigm. Alaffia is a new kind of claims operations partner for health plans. Using expert clinicians and transparent AI we deliver deeper insights smarter automation and consistently better outcomes across the entire lifecycle of claims. With Alaffia health plans can cut wasted spending more effectively than ever — and provide their members the most affordable care. We’re a high-growth venture-backed Series B healthtech startup based in NYC and are actively scaling our company. Join us in helping to build a healthcare system that works better for everyone.