Alaffia Health Benefits Overview

Perform inpatient DRG validation audits and clinical reviews of medical records and claims to verify diagnoses, procedures, CCs/MCCs, sequencing, and discharge status. Document defensible findings, ensure compliance with ICD-10 and DRG grouper rules, support QA, and collaborate with operations, product, and engineering to improve audit logic and automation.

The Clinical Payment Integrity Analyst reviews medical claims and patient records, audits for coding violations, and ensures compliance with healthcare payment guidelines.

Lead strategy, growth, and delivery of clinical payment integrity offerings for health plan clients. Build and mentor a high-performing client-facing team, sponsor strategic accounts, partner with Product/Engineering/Sales to shape AI-enabled claims solutions, drive revenue expansion, ensure operational excellence, and represent the company at industry forums.