About Alaffia & Our Mission

The U.S. healthcare system suffers from over $300B in improper payments each year due to fraud, waste, abuse, and processing errors. We’re on a mission to change that. To best prevent inaccurate payments, we’ve assembled a team of experienced technologists and industry-leading healthcare domain experts. The Alaffia team has alumni ranging from Amazon, Goldman Sachs, the Centers for Medicare and Medicaid Services, and other leading healthcare and financial institutions. We’re also backed by industry-leading venture capital firms!

If you want to make a major impact at the core of U.S. healthcare by implementing the latest in cutting-edge technologies, then we’d like to meet you.

Our Culture

At Alaffia, we fundamentally believe that the whole is more valuable than the sum of its individual parts. Further to that point, we believe a diverse team of individuals with various backgrounds, ideologies, and types of training generates the most value. Our people are entrepreneurial by nature, problem solvers, and passionate about what they do — both inside and outside of the office.

About the Role & What You’ll Be Doing

Alaffia is automating medical claim audits to reduce and recover the billions of dollars medical insurance companies improperly pay to medical providers each year. Health plans and auditors trust the Alaffia platform to rapidly execute post-payment claims audits.

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 that will deliver automated audit results. You will be performing high-dollar 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.

Your Responsibilities

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

What We’re Looking For

• FACILITY INPATIENT CODING/AUDITING EXPERIENCE REQUIRED
• 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
• At least one of the following certifications is mandatory (CPC/COC/CIC/CRC/CPMA)
• Based in New York
• Clinical license preferred (RN)
• Experience working at an insurance company (preferred) 
• Would consider 100% remote for the right candidate

What Else Do You Get Working With Us?

• Medical, Dental, and Vision benefits
• Flexible, paid vacation policy
• Work in a flat organizational structure — direct access to Leadership

LI-REMOTE