Clinical Coding Auditor (RN, CPC)

Alaffia Health

5h•Remote

About The Position

Alaffia is a healthtech startup focused on reducing wasted spending in the healthcare system through expert clinicians and transparent AI. They partner with health plans to deliver deeper insights, smarter automation, and better outcomes across the claims lifecycle. This role involves reviewing and analyzing medical claims, patient medical records, and automatic claim audit results to help train AI models. The position is integral to engineering teams and will help shape the future of healthcare claims auditing. The company is based in NYC and is venture-backed. Authorization to work in the U.S. is required, and visa sponsorship is not available.

Requirements

Facility Inpatient Coding/Auditing Experience (Required)
At least one of the following certifications is mandatory (CPC/CIC/CRC/CPMA)
Clinical license (RN) required
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

Nice To Haves

Experience working at an insurance company (preferred)

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