Inpatient Coder Senior Associate

Summary

Join the Payment Integrity team at Clover Health as a Senior Associate - Inpatient Coder to ensure accurate claims payments and recover overpayments. You will work with clinical, claims, and payment integrity peers to review claims for DRG related issues and proactively identify overpayments.

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 all inpatient services
• Prepare response letters to deliver our decisions to members and/or providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS)
• Act as a subject-matter expert for cross-functional clinical reviews: digest complex concepts and regulations and communicate them effectively to different stakeholders, including senior-level leadership
• Research and respond to external auditor concerns/questions regarding the completeness and accuracy of data creation and integration
• Work closely with data scientists, engineers and operational teams to create sustainable and scalable solutions
• Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams
• Identify and review potential program efficiencies and opportunities
• Continue to analyze existing policies to ensure accuracy and proper execution
• Communicate effectively both internally and externally to ensure accurate claims adjudication and proper provider notification