Inpatient Coder Associate, Payment Integrity
Core
Review inpatient medical claims to ensure accurate payments, identify overpayments, and validate clinical rationale for billed procedures.
Role type
Inpatient clinical coder (payment integrity)
Builds
Accurate claims adjudication and overpayment recovery for Clover Health members
Domain
Healthcare insurance / Medical billing and coding
Required skills
CCS or CIC certification, DRG pricing methodology knowledge, inpatient clinical coding experience, medical records review, Excel, PowerPoint
Preferred skills
Medicare or Medicare Advantage payment integrity experience, claims operations experience
Responsibilities
Review claims for DRG related issues on prospective and retrospective basis, Identify overpayments to ensure accurate claims payments, Collaborate with MDs to verify clinical rationale behind billed procedures, Communicate with multi-discipline teams to ensure accurate claims adjudication
Seniority
Associate, entry-level IC
