Director, Payment Integrity: Lead a Scalable Audit Engine

Alaffia Health; United States; On-site; USD 180,000 - 260,000; Full time

Benefits offered by this job

Competitive compensation package

Medical, Dental and Vision benefits

Flexible, paid vacation policy

Direct access to Leadership

Job summary

Alaffia Health, a NYC-based healthtech startup, is seeking a Director of Payment Integrity to own the strategy, performance, and scale of our PI programs across DRG Validation, Clinical Validation, IBR/HBA, and related reviews. You’ll lead Managers and a broader team, set KPIs, and partner with product and engineering on AI-driven workflow improvements.

Ideal candidates have 8+ years in PI or clinical auditing, with 4+ years in people leadership, prepay and postpay experience, and a proven track

Qualifications

• Active RN license or higher-level clinical license — required.
• 8+ years in Payment Integrity, with 4+ years managing managers / team leads.
• Deep hands-on operational experience across DRG Validation, Clinical Validation, IBR/HBA, and related PI reviews.
• Experience leading both prepay and postpay PI programs.
• Built or scaled a PI program, service line, workflow, or operating model.
• Owns program-level QA and KPIs — audit accuracy, throughput, SLA, findings, savings.
• Knowledge of CPT, ICD-10-CM/PCS, HCPCS, DRGs, APCs, revenue codes.
• Executive communication skills with client executives and providers.

Responsibilities

• Own the overall strategy, roadmap, and operating model for the Payment Integrity program.
• Lead and develop a team of Managers and ensure high-performing review teams.
• Set org-wide performance standards and targets for audit accuracy and throughput.
• Build multi-quarter capacity plans for headcount and workload.
• Represent Payment Integrity in budgeting and leadership discussions.
• Serve as senior clinical authority for audit quality across the program.
• Establish escalation paths for high-complexity disputes and final calls.
• Partner with Product/Engineering on AI-enabled review workflows.
• Own SLA performance and client-facing reporting across programs.

Skills

Leadership

Program management

Clinical auditing

Executive communication

Capacity planning

SOPs & QA

Vendor management

Education

RN license (or higher)

Clinical coding certifications (CIC/CCS/CPC/CPMA/CRC)

Tools

AI-enabled review tools

Job description

Alaffia Health, a NYC-based healthtech startup, is seeking a Director of Payment Integrity to own the strategy, performance, and scale of our PI programs across DRG Validation, Clinical Validation, IBR/HBA, and related reviews. You’ll lead Managers and a broader team, set KPIs, and partner with product and engineering on AI-driven workflow improvements.

Ideal candidates have 8+ years in PI or clinical auditing, with 4+ years in people leadership, prepay and postpay experience, and a proven track