Medical Bill Auditor
4 weeks ago
About Alaffia Health & Our Mission
At Alaffia Health, we're tackling the $500B issue of medical billing fraud, waste, and administrative burden in the U.S. healthcare system. Our team of clinicians, AI/ML engineers, and product experts is building advanced AI to reduce healthcare costs. We're a high-growth, venture-backed startup based in NYC, actively scaling our company.
About the Role & Responsibilities
We're seeking a Medical Bill Auditor to review and analyze medical claims, patient medical records, and automatic claim audit results. You'll work with our team to empower clients with technology that modernizes medical claim auditing.
Your Key Responsibilities
- Review UB-04/IBs for coding/billing violations
- Audit revenue codes against clinical documentation
- Confirm services billed were rendered
- Document inconsistencies with claims billed vs health plan payments
- Verify automatic audit results based on national and payer-specific guidelines
What We're Looking For
- FACILITY INPATIENT CODING/AUDITING EXPERIENCE REQUIRED
- Clinical license required (RN) 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
- 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
- At least one of the following certifications is mandatory (CPC/COC/CIC/CRC/CPMA)
- Experience working at an insurance company (preferred)
Our Culture
We believe a diverse team 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, then we'd like to meet you.
What Else Do You Get Working With Us?
- Medical, Dental, and Vision benefits
- Flexible, paid vacation policy
- Work in a flat organizational structure — direct access to Leadership
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