Teams at Alaffia Health

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.