Job Description

Itemized Bill and Medical Record Reviewer

Job type: Full Time Department: Payment Integrity Work type: Remote USD 70000 -90000 / year

United States

About Alaffia & Our Mission

Each year, the U.S. healthcare system suffers from over $500B in wasted spending due to medical billing fraud, waste, and administrative burden. At Alaffia, were committed to changing that paradigm. Weve assembled a team of clinicians, AI engineers, and product experts to build advanced AI solutions that will directly bend the cost curve for all patients across the healthcare ecosystem. Collectively, were building best-in-class AI software to provide our customers with co-pilot tools, AI agents, and other cutting?edge solutions to reduce administrative burden and reduce healthcare costs.

Were a high-growth, venture-backed startup based in NYC and are actively scaling our company.

About the Role

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 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 Responsibilities

• Combing 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

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 are passionate about what they do both inside and outside of the office.

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
• Autofill application
• Save time by importing your resume in one of the following formats: .pdf or .docx.

Equal Opportunity Employer

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Alaffia Health is a Government contractor subject to the Section 4212 of the Vietnam Era Veterans's Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, which requires Government contractors to take affirmative action to employ and advance in employment: (1) Disabled veterans - A veteran who served on active duty in the U.S. military and is entitled to disability compensation (or who but for the receipt of military retired pay would be entitled to disability compensation) under laws administered by the Secretary of Veterans Affairs, or was discharged or released from active duty because of a service?connected disability; (2) Recently separated veteran - A veteran separated during the three?year period beginning on the date of the veteran's discharge or release from active duty in the U.S military, ground, naval, or air service; (3) Active duty wartime or campaign badge veteran - A veteran who served on active duty in the U.S. military during a war, or in a campaign or expedition for which a campaign badge was authorized under the laws administered by the Department of Defense; (4) Armed forces service medal veteran - A veteran who, while serving on active duty in the U.S. military ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 Fed. Reg. 1209). If you believe that you belong to any of the categories of protected veterans, please indicate by making the appropriate selection.

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Alaffia Health does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.

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