Itemized Bill and Medical Record Reviewer
About the position Alaffia is a healthtech startup focused on reducing waste and inefficiency in the U.S. healthcare system through advanced claims operations. We utilize expert clinicians and AI to provide deeper insights, smarter automation, and improved outcomes in medical claims processing. This role involves reviewing and analyzing medical claims, patient medical records, and automated audit results to help train our AI systems. The position is integral to our engineering teams and will contribute to shaping the future of healthcare claims auditing. This position requires current authorization to work in the United States, and visa sponsorship is not available.
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
Requirements
- Facility Inpatient Coding/Auditing Experience (Required)
- At least one of the following certifications is mandatory (CPC/CIC/CRC/CPMA)
- 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
- Clinical license (RN) preferred
- Experience working at an insurance company (preferred)
Benefits
- Medical, Dental and Vision benefits
- Flexible, paid vacation policy
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