Associate Payment Integrity
Associate Payment Integrity
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$ 72000 - 100000
1 Vacancy
Job Description
At Clover Health we are committed to providing highquality affordable and easytounderstand healthcare plans for Americas seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each members complete health history we ensure better care at a lower costdelivering the highest value to those who need it most.
The Payment Integrity team is a motivated collaborative team sitting at the intersection of Clovers provider relationship operations data infrastructure and software. The Payment Integrity team ensures that Clover pays claims in a fair transparent compliant and medically justified manner. Come join us as we discover new opportunities to improve the financial health of Clover while strengthening provider relationships and building a better healthcare system.
As an Associate for Payment Integrity Vendor Management at Clover Health you will be responsible for the management of cost containment vendors. You will be responsible for ensuring adherence to servicelevel agreements and compliance with Clovers internal policies and procedures while maximizing the return on investment driven by each vendor.
As an Associate Payment Integrity you will:
- Oversee daytoday operations of Clovers cost containment vendors. Serve as pointofcontact between external vendors and various operations teams within Clover.
- Monitor evaluate and report on overpayment inventory to ensure for findings accuracy adherence to SLAs and compliance with Clover P&Ps. Review and approve vendor overpayment identifications prior to pursuit.
- Identify research and resolve complex and escalated claim payment issues originating from vendor findings.
- Manage workflows and processing of vendor identifications from quality review through recovery with a focus on developing efficiencies for future growth.
Success in this role looks like:
- By the end of your initial 90day period you have seamlessly integrated into the Payment Integrity Team and started to establish strong relationships with key internal and external vendor partners. You have developed a foundational knowledge of work streams in which you are responsible for and have a strong understanding of audit concepts that derive overpayment recovery inventories.
- By 6 months you will be working autonomously to execute on daytoday functions that drive quality and consistent flow of postpay inventories. You have demonstrated a deep understanding of workflows that support the audit life cycle and maintain compliance with aging requirements.
- Future success in this role will be measured by accuracy the ability to meet predetermined monthly targets and contributions towards ongoing process improvements.
You should get in touch if:
- You hold a BA/BS degree or equivalent experience along with 2 years of experience in the healthcare industry with deep exposure to Payment Integrity and Medicare Advantage.
- You have 2 years of experience billing coding processing and/or auditing claims along with knowledge of correct coding guidelines (CPT HCPCS DRG and ICD 9/10 and reimbursement methodologies (FFS/professional APC DRG etc.. Coding certification through AAPC or AHIMA a plus.
- You are technologically savvy with strong computer skills in Access Excel Visio PowerPoint and basic knowledge of SQL. Knowledge of statistical methods used in the evaluation of healthcare claims data preferred. Google Sheets and Docs are a plus.
- You have a working knowledge of CMS rules and regulations.
- You have experience with payment integrity vendor business partners.
- You are available during Eastern/Central US business hours; candidates in these time zones preferred.
Benefits Overview:
- Financial WellBeing: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally we offer a performancebased bonus program 401k matching and regular compensation reviews to recognize and reward exceptional contributions.
- Physical WellBeing: We prioritize the health and wellbeing of our employees and their families by providing comprehensive medical dental and vision coverage. Your health matters to us and we invest in ensuring you have access to quality healthcare.
- Mental WellBeing: We understand the importance of mental health in fostering productivity and maintaining worklife balance. To support this we offer initiatives such as NoMeeting Fridays monthly company holidays access to mental health resources and a generous flexible timeoff policy. Additionally we embrace a remotefirst culture that supports collaboration and flexibility allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer learning programs mentorship professional development funding and regular performance feedback and reviews.
Additional Perks:
- Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
- Reimbursement for office setup expenses
- Monthly cell phone & internet stipend
- Remotefirst culture enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken so weve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and missiondriven individuals with diverse areas of expertise working together to solve the most complicated problem in the world: healthcare.
From Clovers inception Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths experiences perspectives opinions and backgrounds who share a passion for improving peoples lives. Diversity not only includes race and gender identity but also age disability status veteran status sexual orientation religion and many other parts of ones identity. All of our employees points of view are key to our success and inclusion is everyones responsibility.
#LIREMOTE
Pursuant to the San Francisco Fair Chance Ordinance we will consider for employment qualified applicants with arrest and conviction records. We are an EVerify company.
For California Colorado New Jersey New York or Washington residents a reasonable estimate of the base salary range for this role can be found below. For candidates residing in other geographic areas the range will be adjusted based on location. Final pay is based on several factors including but not limited to internal equity market data and the applicants education work experience certifications etc.
Colorado/Washington Pay Range
$72000 $90000
California/New Jersey/New York Pay Range
$72000 $100000
Required Experience:
IC
Employment Type
Full Time
