Medical Claim/Bill Reviewer (Inpatient)
📋 Role Overview & Responsibilities
About Alaffia & Our MissionEach year, the U.S. healthcare system suffers from over $500B in wasted spending due to medical billing fraud, waste, and administrative burden. At Alaffia, we’re on a mission to change that. We’ve assembled a team of clinicians, AI/ML engineers, and product experts to build advanced AI that finally bends the cost curve for all patients across our ecosystem. We’re a high-growth, venture-backed startup based in NYC and are actively scaling our company.
About the Role & What You’ll Be DoingWe 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 violationsAuditing revenue codes against clinical documentationConfirmation of services billed were renderedClear documentation of inconsistencies with claims billed vs health plan paymentsConfirming automatic audit results based on national and payer-specific guidelines
What We’re Looking ForFACILITY INPATIENT CODING/AUDITING EXPERIENCE REQUIREDDeep background in medical billing, coding, or auditing of insurance claims and medical recordsExperience 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/codingKnowledge of PHI/HIPAA compliance and standardsAbility to research and verify claim coding accuracyMinimum of 3 years of auditing/bill review experienceAt least one of the following certifications is mandatory (CPC/COC/CIC/CRC/CPMA)Based in New YorkClinical license preferred (RN)Experience working at an insurance company (preferred) Would consider 100% remote for the right candidate
Our CultureAt 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. If you want to work alongside driven people on a mission 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!
What Else Do You Get Working With Us?Medical, Dental, and Vision benefitsFlexible, paid vacation policyWork in a flat organizational structure — direct access to Leadership
LI-REMOTE
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