Role Description As a Senior IT/GRC Auditor, you’ll lead day-to-day activities for SOC 2 and other IT compliance engagements. You will guide staff, engage with clients, and play a key role in the delivery of high-quality audits and readiness assessments. Key Responsibilities - Lead ITGC and application control testing efforts - Guide and review work completed by junior team members - Perform walkthroughs, testing, and documentation for SOC 2, SOC 1, and HIPAA engagements - Identify control gaps and provide recommendations for remediation - Maintain strong client relationships through clear and proactive communication - Ensure timely progress updates and escalate issues to management Qualifications - 3–4 years of experience performing IT audits, with a focus on ITGC and application controls - Strong working knowledge of SOC 2 and related frameworks - Bachelor’s degree in Accounting, MIS, Cybersecurity, or a related field - Strong client communication and project management skills - Bilingual in English required Requirements - Experience with GRC tools (e.g., Vanta, Drata, Secureframe) - Familiarity with cloud environments such as AWS, Azure, or GCP - Progress toward CISA, CPA, CISSP, ISO 27001 Lead Auditor Benefits - Remote work with flexible hours - Paid holidays and time off - Growth opportunities in a fast-paced firm - Bonus incentives tied to performance

• Performs chart reviews and issues communications to assure complete and accurate documentation • Analyzes reports for documentation and coding trends • Interacts with clinicians to obtain and promote appropriate clinical documentation • Reviews medical records to identify potential gaps in documentation • Queries clinicians to obtain accurate and complete documentation • Maintains or exceeds established quality and productivity standards • Works closely with coding staff to assure LOS coded was supported by documentation • Develops and implements clinician/coder education based on chart review findings

• Conduct 3rd party product certification audits across varied environments. • Ensure compliance with BSI’s rigorous Benchmark schemes. • Take clients through their audit process from opening meetings to presenting findings. • Support the recommendation for the issue, re-issue, or withdrawal of certificates.

Title: Clinical DRG Auditor Location: United States, New York, New York, United States Job Description: Job type: Full Time · Department: Payment Integrity · Work type: Remote · USD 85,000-95,000 / year United States; New York, New York, United States Job details About Alaffia & Our Mission Every year, U.S. health plans lose billions to improper payments and administrative waste. That wasted spending ultimately trickles down across the healthcare ecosystem, driving up costs for plans, providers, and patients alike. We’re here to change that paradigm. Alaffia is a new kind of claims operations partner for health plans. Using expert clinicians and transparent AI, we deliver deeper insights, smarter automation, and consistently better outcomes across the entire lifecycle of claims. With Alaffia, health plans can cut wasted spending more effectively than ever — and provide their members the most affordable care. We’re a high-growth, venture-backed Series B healthtech startup based in NYC and are actively scaling our company. Join us in helping to build a healthcare system that works better for everyone. *This position requires current authorization to work in the United States. Unfortunately, we are not in a position to sponsor work visas at this time. About the Role Alaffia is seeking an experienced Clinical DRG Auditor to join our Payment Integrity team. In this role, you will perform inpatient Diagnosis-Related Group (DRG) validation audits and detailed clinical reviews of medical records and claims. You will leverage your clinical expertise and deep understanding of reimbursement, documentation standards, and coding guidelines to identify unsupported DRGs, improve payment accuracy, and inform audit automation. This role is ideal for an RN or LPN with hands-on experience in clinical DRG validation, inpatient auditing, or CDI-adjacent review work. What You'll be Doing Clinical DRG Review & Validation - Perform comprehensive clinical DRG audits on inpatient claims, including validation of principal diagnosis, secondary diagnoses, CCs/MCCs, procedures, sequencing, and discharge status. - Evaluate whether clinical documentation supports the billed DRG in accordance with CMS guidelines, payer policies, and nationally accepted standards of care. - Apply clinical judgment and clinical guidelines to interpret complex inpatient medical records, including physician notes, labs, imaging, procedures, and treatment plans. - Identify documentation gaps, unsupported diagnoses, and DRG upcoding or misclassification. Audit Documentation & Reporting - Produce clear, defensible audit findings with concise clinical rationale. - Accurately document audit determinations in Alaffia’s audit platform and supporting tools. - Support quality assurance processes and peer review as needed. Compliance & Policy Adherence - Maintain working knowledge of ICD-10-CM/PCS coding principles, DRG groupers (MS-DRG, APR-DRG, AP-DRG as applicable), CMS guidance, and payer-specific reimbursement policies. - Ensure all audit activity complies with HIPAA, regulatory requirements, and internal SOPs. Cross-Functional Collaboration - Collaborate with payment integrity operations, product, and engineering teams to provide clinical insight that informs audit logic and AI-driven review models. - Contribute to ongoing process improvements, training, and audit optimization initiatives. Who You Are Required Qualifications - Active Registered Nurse (RN) license or Licensed Practical Nurse (LPN) license. - 3+ years of experience performing clinical DRG validation, inpatient clinical review, DRG auditing, CDI review, or similar payment integrity work. - Strong ability to interpret inpatient medical records and assess clinical validity of diagnoses and procedures. - Experience applying clinical judgment in a reimbursement or audit context. Preferred Qualifications - Direct experience conducting DRG audits for payers, vendors, or consulting organizations. - Working knowledge of inpatient reimbursement methodologies and hospital billing workflows. - Familiarity with payer audit programs, pre-pay or post-pay reviews, and appeals support. - Experience working with audit platforms, EHRs, and claims data systems. Certifications (Preferred, Not Required) - CPC, CCS, CIC, CPMA, CCDS, CDIP, or similar clinical/coding/audit certification. Core Competencies - Strong analytical and critical-thinking skills with exceptional attention to detail. - Clear written communication skills with the ability to articulate clinical rationale. - Ability to work independently in a remote environment and manage competing priorities. Our Culture Alaffia was born out of our founders’ personal connection to the inefficiency of the U.S. healthcare system. We are deeply mission-driven, with an abiding belief that technology can help create a better future for everyone — and we’re looking for others who share our passion for change to join the team. What Else Do You Get Working With Us? 401(k), Medical, Dental, and Vision benefits Flexible, paid vacation policy Work in a flat organizational structure — direct access to Leadership