Inpatient Coder Associate, Payment Integrity

Clover Health

12d•$80,000 - $110,000•Remote

About The Position

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.

Requirements

CCS or CIC certification; required.
Knowledge of DRG pricing methodology; required.
Technologically savvy with strong computer skills in Excel and PowerPoint.

Nice To Haves

1-2 years of experience in inpatient clinical coding; preferred
Medicare or Medicare Advantage payment integrity or claims operations experience; preferred

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.