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Inpatient Coder Associate, Payment Integrity

1 month, 4 weeks ago
United States
Full-time
Junior
Operations Specialist
Data Science and Analytics
Apply Now
Clover Health

Clover Health

Clover Health is a data-focused health insurance company that is revolutionizing the Medicare Advantage space by integrating innovative technology into its plans. With a focus on optimizing medical outcomes and reducing costs, Clover Health uses analyt...

Insurance
251-1K
Founded 2014
$925M raised
View All Jobs 23

Description

  • Review inpatient claims prospectively and retrospectively for DRG-related issues that may drive inaccurate provider payments.
  • Proactively identify overpayments on inpatient services and support recovery efforts when errors are found.
  • Partner with Clinical, Claims, and Payment Integrity teams to validate claim accuracy and adjudication outcomes.
  • Participate in discussions with physicians to verify the clinical rationale behind billed procedures.
  • Communicate with internal and external stakeholders to support accurate claims adjudication and provider notification.
  • Coordinate identification of provider DRG denials and upcoding cases.
  • Apply clinical coding practices and medical record review to support DRG validation workflows.
  • Maintain quality assurance standards and regulatory compliance in claims processing practices.

Requirements

  • CCS or CIC certification is required.
  • Knowledge of DRG pricing methodology is required.
  • 1-2 years of experience in inpatient clinical coding is preferred.
  • Experience with Medicare or Medicare Advantage payment integrity or claims operations is preferred.
  • Strong computer skills in Excel and PowerPoint are required.
  • Technologically savvy with the ability to work effectively in clinical review workflows.
  • Ability to build strong cross-functional relationships across multiple disciplines.
  • Understanding of clinical coding practices and medical records review.
  • Ability to work autonomously within review workflows by around 6 months.
  • Comfort working in a remote-first environment.

Benefits

  • Competitive base salary of $80,000-$110,000 USD.
  • Equity opportunities, including an Employee Stock Purchase Plan (ESPP).
  • Performance-based bonus program.
  • 401(k) matching.
  • Comprehensive medical, dental, and vision coverage.
  • Flexible time-off policy and monthly company holidays.
  • Mental health resources and No-Meeting Fridays.
  • Remote-first culture with flexibility to work from any location.
  • Learning programs, mentorship, and professional development funding.
  • Paid parental leave for all new parents.
  • Office setup reimbursement.
  • Monthly cell phone and internet stipend.

Interested in this position?

Apply directly on the company website

Apply Now

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