CMS Encounter Data Engineer

Clover Health

1d • $108,000 - $132,000 • Remote

About The Position

We don't just provide health insurance—we deliver the kind of healthcare that people deserve. The Risk Adjustment team at Clover is made up of collaborative and strategic thinkers who are excited about the impact technology can have on healthcare. In this role, you will partner and help support a core area of responsibility for our Risk Adjustment team, helping ensure the accuracy, integrity, and performance of our encounter data and risk adjustment operations. Your work will directly influence revenue accuracy, compliance, and our ability to reinvest in better care for our members.
We're looking for a tech-savvy individual who is interested in enhancing Clover’s ability to make smart, data-driven business decisions to join our team. This person thrives at the intersection of engineering, analytics, and operations, and is motivated by solving complex data challenges in a highly regulated environment. You are energized by building scalable processes, improving data quality, and collaborating cross-functionally to drive measurable impact.

Requirements

• You have two years experience with Medicare Risk Adjustment, CMS EDS submissions, and healthcare claims data.
• You have at least two years of programmers experience using SQL, Python, and R.
• You have experience with building operational level dashboards.
• You are a self-starter, have a high degree of internal drive and motivation, and desire to execute at a high level.
• You are relentlessly focused on serving the needs of diverse business customers.

Responsibilities

• Be responsible for the monitoring and management of the end to end data flow of data submissions to vendors and government agencies to mitigate data leakage and submission errors.
• Own the claim and supplemental submission workflow for CMS EDS submissions.
• Develop data pipeline tracking reports and analyze, research, and resolve encounter data errors.
• Support the claim and supplemental submission workflow for CMS EDS submissions.
• Collaborate closely between the Engineering and Risk Adjustment teams.
• Assist with, track, and implement risk adjustment related initiatives and strategies.
• Maintain, update, and create policies, procedures, and other documentation around the encounter process.

Benefits

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
• Physical Well-Being: We prioritize the health and well-being 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 Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first 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.
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed