Jobs at Alaffia Health

Leads and scales the account management function for enterprise health plan customers. Manages Account Managers, owns team revenue and retention targets, develops account processes and playbooks, and oversees strategic accounts. Builds executive relationships, leads QBRs, manages escalations, identifies expansion opportunities, and partners with Sales, Product, Engineering, and Leadership to improve customer outcomes, retention, and revenue growth.

Owns relationships, onboarding, implementation, renewals, retention, expansion, and revenue growth for health plan customers. Leads product rollouts, quarterly business reviews, ROI optimization, volume monitoring, executive relationship management, and cross-functional customer feedback. Requires B2B account management or customer success experience, healthcare payment integrity knowledge, SaaS implementation expertise, quota performance, and strong communication and project management skills.

Drive enterprise SaaS and services sales to health insurance plans within an assigned territory. Responsibilities include prospecting, nurturing, and closing high-value opportunities; delivering customized presentations and product demonstrations; exceeding revenue targets; tracking pipelines and forecasts in HubSpot; and communicating AI platform value, ROI, and payer-market insights to health plan executives.

Reviews high-dollar inpatient facility bills, medical records, and automated audit results for coding, billing, documentation, and payment accuracy. Audits UB-04s, revenue codes, and itemized charges against clinical records and national or payer-specific guidelines. Documents claim inconsistencies, confirms services were rendered, researches coding accuracy, and helps train automated claims-auditing systems. Requires inpatient coding or auditing experience, a coding certification, and at least three years of bill review experience.

Alaffia’s Talent Pool invites candidates interested in future opportunities at its NYC-based healthcare AI startup. Applicants can submit their information and a cover letter describing their motivation and preferred business areas or roles. The talent team will retain profiles and proactively contact candidates when suitable positions become available. The company develops AI-powered copilots and agents to reduce healthcare administrative burden, billing waste, and costs.

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.

Review and investigate provider disputes for high-dollar facility claims and itemized bills. Analyze UB-04s, itemized bills, medical records, and audit findings to determine whether Payment Integrity findings should be upheld, modified, or overturned. Apply coding and reimbursement guidelines (CPT, ICD-10, HCPCS, DRGs, APCs), document defensible decisions, manage a high-volume queue, and collaborate with Payment Integrity teams while ensuring PHI/HIPAA compliance.

Lead strategy, performance, and scaling of Payment Integrity review programs (IBR, medical record review, DRG validation). Manage managers, set quality/KPI targets, own audit governance, SOPs, capacity planning, client reporting/escalations, and partner with Product/Engineering on AI-assisted workflows.