Itemized Bill and Medical Record Reviewer

Itemized Bill and Medical Record Reviewer

Job type:
Full Time
· Department:
Payment Integrity
· Work type:
Remote
· USD 70000
-90000 / year

United States

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.

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.

• 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

• Facility Inpatient Coding/Auditing Experience (Required)
• At least one of the following certifications is mandatory (CPC/CIC/CRC/CPMA)
• Clinical license (RN) preferred
• Experience working at an insurance company (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 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

At Alaffia, we fundamentally believe that the whole is more valuable than the sum of its individual parts. Further to that point, we believe a diverse team of individuals with various backgrounds, ideologies, and types of training generates the most value. Our people are entrepreneurial by nature, problem solvers, and are passionate about what they do — both inside and outside of the office.

• Competitive compensation package
• Medical, Dental and Vision benefits
• Flexible, paid vacation policy
• Work in a flat organizational structure — direct access to Leadership
• Autofill application
• Save time by importing your resume in one of the following formats: .pdf or .docx.

Equal Opportunity Employer

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Alaffia Health is a Government contractor subject to the Section 4212 of the Vietnam Era Veterans's Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, which requires Government contractors to take affirmative action to employ and advance in…