Alaffia Health Benefits Overview

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 Sales Strategy Associate will support sales efforts through market research, executive meeting preparation, ROI modeling, and proposal development. The role focuses on analytics and strategy to drive pipeline growth and enable insightful engagements with health plan executives.

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