The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover's 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 an Inpatient Clinical Coder 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 Clover’s medical claims are paid accurately and recovering overpayments when they are identified. The Associate - Inpatient Coder coordinates the identification of provider DRG denials and upcoding
As an Inpatient Clinical Coder, 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 inpatient services
Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures
Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams
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 90-day 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
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
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 or CIC certification; required
Knowledge of DRG pricing methodology; required
You have 1-2 years of experience in inpatient clinical coding; preferred Medicare or Medicare Advantage payment integrity or claims operations experience; preferred You are technologically savvy with strong computer skills in Excel and PowerPoint
Benefits Overview : Financial Well-Being : Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performan