Inpatient Coder Senior Associate

The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clovers provider Network Claims and Tech teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner with a particular focus on reducing inappropriate medical spend.

As a Senior Associate Inpatient Coder for Payment Integrity at Clover Health you will play a key role ensuring that Clover is able to continue to build and scale a compliant efficient and profitable program. You will work to ensure quality assurance standards and regulatory policy are reflected in claims processing practices. You will help drive value for every member by ensuring that Clovers medical claims are paid accurately and recovering overpayments when they are identified. The Senior Associate Inpatient Coder monitors and coordinates the identification of provider DRG denials and upcoding.

As an Inpatient Coder Senior Associate you will:

• Partner with Clinical Claims and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers.
• Proactively identify overpayments to ensure accurate claims payments on all inpatient services.
• Prepare response letters to deliver our decisions to members and/or providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS).
• Act as a subjectmatter expert for crossfunctional clinical reviews: digest complex concepts and regulations and communicate them effectively to different stakeholders including seniorlevel leadership.
• Research and respond to external auditor concerns/questions regarding the completeness and accuracy of data creation and integration.
• Work closely with data scientists engineers and operational teams to create sustainable and scalable solutions.
• Communicate effectively while building trust and lasting partnerships both laterally and vertically across multidiscipline teams.
• Identify and review potential program efficiencies and opportunities.
• Continue to analyze existing policies to ensure accuracy and proper execution.
• Communicate effectively both internally and externally to ensure accurate claims adjudication and proper provider notification.
  

Success in this role looks like:

• By the end of your initial 90day period you will have demonstrated a strong understanding of clinical coding practices and medical records review while assisting our team in areas of DRG validation avoidable readmission reviews and clinical appeal reviews.
• By 6 months you will be working autonomously to execute within our clinical review workflows and will have developed strong interpersonal relationships across the organization becoming a trusted subject matter expert.
• Continued success in this position anchors in on developing a deep understanding of the workflows that support our clinical review life cycle while maintaining regulatory compliance standards.
  

You should get in touch if:

• You hold a CCS certification or similar inpatient coding certification; required.
• You have a deep knowledge and understanding of DRG pricing methodology; required.
• You have current or previous nursing or firsthand clinical experience; preferred.
• You have 5 years of experience in inpatient clinical coding; preferred.
• You have Medicare or Medicare Advantage payment integrity or claims operations experience; preferred
• You are technologically savvy with strong computer skills in Excel and PowerPoint.
• You have knowledge of statistical methods used in the evaluation of healthcare claims data and SQL a plus.
  

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 $99000

California/New Jersey/New York Pay Range

$72000 $110000