Alaffia Health Benefits Overview

Full-cycle recruiter for Payment Integrity and Managed Services hiring: manage multiple high-volume requisitions, source and screen candidates, coordinate interviews, maintain ATS records, build pipelines, advise hiring managers, and support recruiting events.

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.