Manager, Itemized Bill and Medical Record Reviewer

Alaffia Health

18d

About The Position

As the Manager, Itemized Bill & Medical Review, you'll lead and oversee a team of Medical Bill Reviewers (Payment Integrity Analysts) responsible for delivering high-quality, high-dollar facility bill audits on behalf of our health plan clients. You'll sit at the intersection of clinical expertise and operational execution, ensuring your team's audit work is accurate, consistent, and scalable while serving as a key counterpart to the Payment Integrity Operations Manager in delivering a seamless end-to-end audit experience. This role is ideal for an experienced bill reviewer and clinical auditor who is ready to step into a leadership position, bring structure to a growing team, and drive the quality and throughput of our Payment Integrity program.

Requirements

5+ years of hands-on experience in medical bill review, facility coding, or clinical auditing with at least 2+ years in a leadership, senior, or supervisory role
Deep expertise in Itemized Bill Review (IBR) and UB-04/facility claim auditing including revenue code validation, charge confirmation, and medical record comparison
At least one of the following certifications is required: CPC, CIC, CRC, CPMA, or equivalent coding/audit certification
Strong working knowledge of national coding guidelines: CPT, ICD-10-CM/PCS, HCPCS, DRGs, APCs, revenue codes, and POS codes
Proven ability to lead and develop a team of clinical reviewers, manage caseloads, and drive performance
Excellent written communication skills with the ability to document clinical rationale clearly and professionally
Strong organizational skills with the ability to manage multiple priorities, reviewers, and client programs concurrently
Knowledge of HIPAA/PHI compliance standards and payer-specific audit policies
Proficient in Excel, Google Sheets, and audit management or workflow platforms
This position requires current authorization to work in the United States. Unfortunately, we are not in a position to sponsor work visas at this time.

Nice To Haves

Active RN or clinical license strongly preferred
Experience working at a health plan, payment integrity vendor, or managed care organization
Familiarity with payer audit programs, pre-pay or post-pay review models, and appeals processes
Background supporting or collaborating with AI/ML model training or validation workflows
Experience working with or alongside DRG validation, readmissions review, or other clinical audit types
Familiarity with revenue cycle operations and hospital billing workflows
Project management experience (Agile, Lean, or similar) preferred