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.
About the RoleWe 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.
Your ResponsibilitiesCombing 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) preferred
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.
What Else Do You Get?Competitive compensation package
Medical, Dental and Vision benefits
Flexible, paid vacation policy
Work in a flat organizational structure — direct access to Leadership
Skills Required
- Current authorization to work in the United States
- Facility inpatient coding or auditing experience
- At least one of the following certifications: CPC, CIC, CRC, or CPMA
- Experience performing audits on line-item charges on itemized bills
- Deep background in medical billing, coding, or auditing insurance claims and medical records
- Experience with CPT, ICD-9/10, HCPCS, POS codes, DRGs, APCs, and other coding systems
- Knowledge of hospital-based billing and coding
- Knowledge of PHI, HIPAA compliance, and related standards
- Ability to research and verify claim coding accuracy
- Minimum of three years of auditing or bill review experience
- Clinical license, such as RN
- Experience working at an insurance company
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.
Alaffia Health Offices
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