Itemized Bill and Medical Record Reviewer

Alaffia Health

About The Position

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, we’re committed to changing that paradigm. We’ve 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, we’re 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. We’re 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.

Requirements

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

Clinical license (RN) preferred
Experience working at an insurance company (preferred)
Experience performing audits on line item charges on Itemized Bills

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