[Hiring] Payment Integrity Manager @Alaffia Health

Role Description

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.

Qualifications

• Must hold an active RN license or higher-level clinical license. LPNs are not eligible.
• 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 preferred: 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.

Requirements

• 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.

Benefits

• Competitive compensation package.
• Medical, Dental and Vision benefits.
• Flexible, paid vacation policy.
• Work in a flat organizational structure — direct access to Leadership.

Company Description

Alaffia is a new kind of claims operations partner for health plans. Using expert clinicians and transparent AI, we deliver deeper insights, smarter automation, and consistently better outcomes across the entire lifecycle of claims. With Alaffia, health plans can cut wasted spending more effectively than ever — and provide their members the most affordable care.

We’re a high-growth, venture-backed Series B healthtech startup based in NYC and are actively scaling our company. Join us in helping to build a healthcare system that works better for everyone.