Inpatient Coder Associate, Payment Integrity
About The Position
The Inpatient Coder Associate on Clover Health’s Payment Integrity team helps ensure medical claims are paid accurately and that overpayments are recovered when identified. The role focuses on identifying provider DRG denials and upcoding, and supporting compliant, efficient claims-processing practices that reflect quality assurance standards and regulatory policy. The position reviews claims for DRG-related issues on prospective and retrospective bases, identifies inpatient-service overpayments, and collaborates with physicians to verify the clinical rationale behind billed procedures. Success involves learning clinical coding and medical-record review practices, becoming proficient in the team’s clinical review workflows, building strong relationships across the organization, and maintaining regulatory compliance. The role is part of a remote-first culture.
Requirements
- CCS or CIC certification is required.
- Knowledge of DRG pricing methodology is required.
- Strong computer skills, including proficiency with Excel and PowerPoint.
Nice To Haves
- 1–2 years of experience in inpatient clinical coding.
- Experience with Medicare or Medicare Advantage payment integrity or claims operations.
Responsibilities
- Partner with Clinical, Claims, and Payment Integrity colleagues to review claims for DRG-related issues prospectively and retrospectively.
- Proactively identify overpayments to support accurate payments for inpatient services.
- Participate in discussions with physicians to verify the clinical rationale behind billed procedures.
- Communicate effectively and build lasting partnerships across multidisciplinary teams.
- Communicate internally and externally to support accurate claims adjudication and appropriate provider notification.
- Coordinate the identification of provider DRG denials and upcoding.
- Execute clinical review workflows and maintain regulatory compliance standards.
Benefits
- Competitive base salary and equity opportunities.
- Performance-based bonus program.
- 401(k) matching.
- Regular compensation reviews.
- Medical, dental, and vision coverage.
- No-Meeting Fridays.
- Monthly company holidays.
- Access to mental health resources.
- Generous flexible time-off policy.
- Remote-first culture.
- Learning programs and mentorship.
- Professional development funding.
- Regular performance feedback and reviews.
- Employee Stock Purchase Plan with discounted equity opportunities.
- Reimbursement for office setup expenses.
- Monthly cell phone and internet stipend.
- Paid parental leave for all new parents.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
