The Payment Integrity team works at the intersection of Clover's provider network, claims, and technology teams to ensure claims are paid accurately and to reduce inappropriate medical spend.
In this role, you will support compliant, efficient, and profitable inpatient coding and review workflows. You will help ensure quality assurance standards and regulatory policy are reflected in claims processing, identify overpayments, and support recovery efforts when necessary. The role also coordinates the identification of provider DRG denials and upcoding.
Requirements & Qualifications
- CCS or CIC certification required.
- Knowledge of DRG pricing methodology required.
- 12 years of experience in inpatient clinical coding preferred.
- Medicare or Medicare Advantage payment integrity or claims operations experience preferred.
- Strong computer skills, including Excel and PowerPoint.
- Ability to collaborate effectively with clinical, claims, and payment integrity teams.
- Strong communication skills and comfort working across multidisciplinary teams.
Benefits & Perks
- Competitive base salary and equity opportunities.
- Performance-based bonus program.
- 401(k) matching.
- Regular compensation reviews.
- Medical, dental, and vision coverage.
- Mental health resources.
- No-Meeting Fridays.
- Monthly company holidays.
- Generous flexible time-off policy.
- Learning programs and mentorship.
- Professional development funding.
- Remote-first culture.
- Employee Stock Purchase Plan (ESPP).
- Reimbursement for office setup expenses.
- Monthly cell phone and internet stipend.
- Paid parental leave for all new parents.
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Salary Range
$80,000 - $110,000
Remote work allowed
Yes
Posted
1 week ago
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