Clinical DRG Validation Specialist (Contractual) - Alaffia Health

About Alaffia & Our Mission

Alaffia Health is at the forefront of healthcare innovation, developing cutting-edge AI tools to enhance clinical decision-making and payment integrity processes. We are seeking a highly skilled Clinical DRG Validation Specialist to join our team and contribute to the development and training of our generative AI-powered clinical tools.

If you want to make a major impact at the core of U.S. healthcare by implementing the latest in cutting-edge technologies, then we’d like to meet you.

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.

Key Responsibilities:

• Annotate Medical Records: Accurately annotate medical records to train and refine our AI models.
• DRG Review/Validation: Conduct comprehensive DRG reviews and validations, focusing on high-risk DRGs such as sepsis, respiratory conditions, and more.
• Evidence Validation: Validate evidence in medical records to support DRG assignments, ensuring all grouper information is accurately reflected.
• Collaboration: Work collaboratively with our AI development team to provide clinical insights and feedback.

What We’re Looking For

• Clinical Practice Experience: Must possess active clinical experience as an RN or MD.
• DRG Expertise: Demonstrated experience in DRG review and validation, particularly with high-risk DRGs.
• Tech Savvy: Proficient in using technology and comfortable working with AI tools.
• Industry Experience: Previous experience working at a health plan, payment integrity firm, or healthcare provider, with a focus on DRG or coding DRG reviews.
• Methodology Knowledge: Deep understanding of MS DRG and APR DRG methodologies.
• Analytical Skills: Ability to validate clinical evidence within medical records to support accurate DRG assignments.

Salary Range

$40-$50 hour

This role would be roughly 200 hours to start with the ability to extend the contract

What Else Do You Get Working With Us?

Competitive compensation package (cash + equity)

Medical, Dental and Vision benefits

Flexible, paid vacation policy

Work in a flat organizational structure — direct access to Leadership

Interested candidates are invited to submit their resume and a cover letter detailing their relevant experience and qualifications. Please include specific examples of your DRG review/validation work and any experience you have with AI tools in healthcare.