Jobs at Alaffia Health

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.

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.