About Alaffia & Our Mission

Each year, the U.S. healthcare system suffers from over $500B in wasted spending due to medical billing fraud, waste, and administrative burden. At Alaffia, we’re committed to changing that paradigm. We’ve assembled a team of clinicians, AI engineers, and product experts to build advanced AI solutions that will directly bend the cost curve for all patients across the healthcare ecosystem. Collectively, we’re building best-in-class AI software to provide our customers with co-pilot tools, AI agents, and other cutting-edge solutions to reduce administrative burden and reduce healthcare costs. 

We’re a high-growth, venture-backed startup based in NYC and are actively scaling our company.

About the Role & What You'll Be Doing

As the Payment Integrity Operations Manager, you’ll own and lead the Payment Integrity Operations function that supports our managed services and audit delivery teams. You’ll oversee the full audit lifecycle—from client onboarding and workflow deployment to ongoing reporting, SOP development, and issue resolution—ensuring a high-quality, scalable experience for our health plan partners.

This role is ideal for a strategic operator with hands-on experience in healthcare, payment integrity, and claim audits including Itemized Bill Review, DRG validation, and readmissions reviews who thrives at building structure, leading teams, and driving execution across multiple client programs.

You’ll manage the PI Ops Analysts and collaborate closely with our Managed Services Review teams to design, implement, and refine the systems, processes, and reporting that power our client engagements.

What We're Looking For

• Lead the full lifecycle of managed service client engagements—from project kickoff through steady-state delivery and reporting.

• Manage new audit programs and workflows (DRG validation, readmissions reviews, or other managed review types).

• Design and document detailed Standard Operating Procedures for every stage of the audit lifecycle: intake, documentation requests, determination, appeals, and client reporting.

• Manage work conducted by the PI Ops Analysts that include: daily tasks: report generation, document requests, provider outreach, backlog management.

• Own and refine internal workflows for escalations, provider communications, client updates, and audit throughput optimization.

Team Leadership

• Directly manage the PI Ops Analyst team: set priorities, monitor KPIs, conduct 1:1s, and coach analysts on workflow execution and client communication best practices.

• Ensure accountability for daily audit task assignments, timely completion, and quality assurance.

• Foster a culture of continuous improvement through process audits, root-cause analysis, and workflow refinement.

Client Implementation & Reporting

• Serve as the project manager for new and existing managed service clients—owning deployment, configuration, and reporting cadence.

• Create and maintain client-facing dashboards, audit summaries, and executive reports summarizing case volumes, savings, turnaround times, and operational trends.

• Manage the client escalation inbox: triage requests, coordinate with internal teams, and ensure prompt, accurate responses.

• Track and deliver all client deliverables in alignment with contractual SOWs (Statements of Work).

Operational Governance & Continuous Improvement

• Establish and maintain SOPs governing internal and client communication standards, task escalation, and reporting workflows.

• Define key operational KPIs (e.g., audit cycle time, backlog rate, SLA adherence, documentation turnaround).

• Collaborate cross-functionally with Clinical Audit, Product, and Technology teams to streamline intake-to-determination workflows.

Who You Are

• 7+ years in healthcare operations, payment integrity, or claims audit delivery, including 2–3+ years managing a team or leading client implementations

• Deep understanding of payment integrity programs, and the audit lifecycle from intake through provider response

• Proven success designing SOPs, managing new audit programs, or managing multi-client delivery teams

• Excellent organizational skills—able to coordinate across analysts, auditors, and clients while managing multiple programs concurrently

• Skilled communicator who can balance technical accuracy with professionalism and empathy in client or provider communications

• Strong analytical and reporting skills; proficient in Excel, Google Sheets, and workflow management systems

• Project management experience (Agile, Lean, or PMP-style practices) strongly preferred

• Familiarity with revenue cycle and healthcare reimbursement methodologies

Our Culture

At Alaffia, we fundamentally believe that the whole is more valuable than the sum of its individual parts. Further to that point, we believe a diverse team of individuals with various backgrounds, ideologies, and types of training generates the most value. Our people are entrepreneurial by nature, problem solvers, and are passionate about what they do — both inside and outside of the office.

What Else Do You Get?

• Competitive compensation package (cash + equity)

• Medical, Dental and Vision benefits

• Flexible, paid vacation policy

• Work in a flat organizational structure — direct access to Leadership