Title: Physician Coder
Location: Remote – USA
Clover is reinventing health insurance by working to keep people healthier.
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. Come join us as we discover new opportunities to improve the financial health of Clover while strengthening provider relationships and building a better healthcare system.
As a Senior Associate, Physician Coder within our Payment Integrity team, you will play a critical role in ensuring that Clover is able to continue to build and scale a compliant, efficient, and financially stable program. You will work to ensure quality assurance standards and regulatory policy are reflected in claims processing practices. A successful Senior Associate, Physician Coder will have a broad coding knowledge base, including but not limited to: DME, Outpatient, ASC and Physician correct coding. This position will focus specifically on Medicare coding policies.
As a Senior Associate, Physician Coder, you will:
- Partner with Clinical, Claims, and Payment Integrity peers to review claims for CPC related issues on a retrospective basis that currently drive inaccurate payments to providers.
- 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 – digest complex Medicare concepts and regulations and communicate them effectively to different stakeholders.
- Research and respond to external auditor concerns/questions regarding the completeness and accuracy of data creation and integration.
- Work closely with analysts 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.
You will love this job if:
- You want to make an impact. You thrive off of helping others, and want your work to make a difference in our members’ lives.
- You are passionate about researching complex regulations and putting it to work for the good of others.
- You are a team player. You enjoy partnering with others, and want to work collaboratively to find new solutions.
- You are a strong communicator. You have strong verbal and written communication skills that foster trust, knowledge sharing, and progress.
- You are detail-oriented. You pay attention to the small things, while understanding how they fit into the bigger picture.
- You are motivated to learn. There is no shortage of technical, clinical, and operational skills to learn at Clover.
- You are curious. You like to do research when you don’t know an answer. You ask the hard questions and you don’t sweep problems under the rug.
You should get in touch if:
- You have 7+ years of experience with CPC coding, experience with CMS regulations preferred.
- You are a Certified Professional Coder (CPC).
- You have prior experience working in health insurance; Medicare Advantage is a plus.
- You have a strong knowledge of the National Rules of Correct Codification defined by CMS in the Manual of CCI and the tables of CCI.
- You have claims, payment integrity or revenue cycle accounting experience – preferred but not required.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we’ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.