Alaffia Health
Payment Integrity Manager (Bill Review) (RN)
US +1 · Manager · Full-time · Posted Oct 7, 2026
- Location
- US
Remote (United States) - Experience
- 5+ years in medical bill review, facility coding, or clinical auditing; at least 2+ years in a leadership, senior, or supervisory role.
- Visa sponsorship
- Requires current authorization to work in the United States; the employer is not able to sponsor work visas.
About the job
Leads a team of medical bill reviewers conducting facility bill audits, ensuring clinical accuracy, timely delivery, and consistent audit workflows for health plan clients.
What you'll do
- Manage reviewer workloads, performance, training, and development.
- Oversee audit quality, resolve escalations, and ensure findings align with coding guidelines and payer policies.
- Manage review workflows and SLAs, improve processes, and collaborate on client reporting and disputes.
What they ask for
- 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, including at least 2+ years in a leadership, senior, or supervisory role.
- Deep expertise in Itemized Bill Review (IBR) and UB-04/facility claim auditing.
- Strong working knowledge of national coding guidelines, including CPT, ICD-10-CM/PCS, HCPCS, DRGs, APCs, revenue codes, and POS codes.
Nice to have
- At least one of CPC, CIC, CRC, CPMA, or equivalent coding/audit certification.
- Experience in payment integrity or managed care, payer audit and appeals programs, AI/ML model workflows, clinical audits, revenue cycle operations, or project management.
Tools
CPT, ICD-10-CM/PCS, HCPCS, DRGs, APCs, Excel, Google Sheets, HIPAA/PHI
AI focus
Preferred background supporting or collaborating with AI/ML model training or validation workflows.
Model-written summary · the original posting is authoritative