InpatientCoderAssociate,PaymentIntegrity

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. As an Inpatient Clinical Coder, you will: 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. Success in this role looks like: By the end of your initial 90-day period, you will have demonstrated a strong understanding of clinical coding practices and medical records review, while assisting our team in areas of DRG validation. By 6 months, you will be working autonomously to execute within our clinical review workflows and will have developed strong interpersonal relationships across the organization. Continued success in this position anchors in on d