Inpatient Coder Associate, Payment Integrity

About the role

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.

Responsibilities

• 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.

Requirements

• 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.

Qualifications

• Strong understanding of clinical coding practices and medical records review, while assisting our team in areas of DRG validation.
• Working autonomously to execute within our clinical review workflows and developing strong interpersonal relationships across the organization by 6 months.
• Developing a deep understanding of the workflows that support our clinical review life cycle, while maintaining regulatory compliance standards.

Skills

• Strong communication and interpersonal skills.
• Proficiency in Excel and PowerPoint.
• Ability to work independently and collaboratively.
• Understanding of DRG pricing methodology and clinical coding practices.

Benefits

• Financial Well-Being: Competitive base salary and equity opportunities, performance-based bonus program, 401k matching, and regular compensation reviews.
• Physical Well-Being: Comprehensive medical, dental, and vision coverage.
• Mental Well-Being: Initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy.
• Professional Development: Learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
• Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, remote-first culture, paid parental leave for all new parents, and much more!

Pay

A reasonable estimate of the base salary range for this role is: $80,000 - $110,000 USD

Schedule

Remote-first culture, enabling collaboration with global teams.