Inpatient Coding Specialist

The role

You will review claims for DRG related issues on a prospective and retrospective basis. You will identify overpayments and collaborate with MDs to verify clinical rationale for billed procedures.

What you will do

• Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues
• 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 across multi-discipline teams
• Communicate effectively internally and externally to ensure accurate claims adjudication and proper provider notification

Required qualifications

• CCS or CIC certification
• Knowledge of DRG pricing methodology
• Strong computer skills in Excel and PowerPoint

Nice to have

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

Benefits

• Competitive base salary
• Equity opportunities
• Performance-based bonus program
• 401k matching
• Regular compensation reviews
• Medical, dental, and vision coverage
• No-Meeting Fridays
• Monthly company holidays
• Access to mental health resources
• Flexible time-off policy
• Learning programs, mentorship, and professional development funding
• Employee Stock Purchase Plan (ESPP)

About the company

Clover is reinventing health insurance by combining the power of data with human empathy. They use custom software and analytics to empower clinical staff to provide personalized care.