Clover is reinventing health insurance by working to keep people healthier.
The Special Investigation Unit (SIU) is a motivated, collaborative team sitting at the intersection of Compliance, Payment Integrity, & Data Infrastructure. The SIU ensures that Clover monitors, identifies & investigates instances of healthcare fraud, waste & abuse (FWA). Come join us as we discover new opportunities to enhance the fight against FWA!
As a Senior Associate, Clinical Coder within our SIU team, you will play a critical role ensuring that Clover is able to continue to build & scale a compliant, effective FWA audit program. You will work to ensure quality assurance standards & regulatory policy are reflected in our audit practices. You will be joining a fast-growing & fast-moving startup at the intersection of healthcare & technology, where you will have the opportunity to develop both your policy & operational skills. A successful Senior Associate, Physician Coder will have a broad clinical & coding knowledge base, including but not limited to: Inpatient, DME, Outpatient, ASC and/or Physician correct coding
As a Senior Associate, Clinical Coder, you will:
- Partner with Clinical, Claims, & Payment Integrity peers to review claims for FWA related issues on a prospective & retrospective basis that currently drive inaccurate payments to providers.
- Prepare response letters to deliver our decisions to providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS).
- Document audit findings include audit finding letters, reports, logs & other supporting documentation
- Act as a subject matter expert - digest complex Medicare concepts & regulations & communicate them effectively to different stakeholders.
- Communicate effectively while building trust & lasting partnerships both laterally & vertically across multi-discipline teams.
You will love this job if:
- You want to make an impact. You thrive off of helping others, & want your work to make a difference in our members' lives.
- You are passionate about researching complex regulations & putting it to work for the good of others.
- You are a team player. You enjoy partnering with others, & want to work collaboratively to find new solutions.
- You are a strong communicator. You have strong verbal & written communication skills that foster trust, knowledge sharing, & 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, & 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 & you don't sweep problems under the rug.
You should get in touch if:
- You have 3+ years of experience with coding, experience with CMS regulations preferred.
- You have a Certified Coder Designation (CPC, CIC, etc.)
- You have 3+ years of clinical experience (RN, LPN, etc.)
- You have a strong knowledge of the National Rules of Correct Codification defined by CMS in the Manual of CCI & the tables of CCI.
- You have claims, SIU or revenue cycle accounting experience - preferred but not required.
- You have a Fraud Investigation Certification (CFE, AHFI, etc.) - preferred but not required.
- You have prior experience working in health insurance; Medicare Advantage is a plus.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest & 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 & analytics to empower our clinical staff to intervene & provide personalized care to the people who need it most.
We always put our members first, & our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate & mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clovers inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer & our employees are people with different strengths, experiences & backgrounds, who share a passion for improving people's lives. Diversity not only includes race & gender identity, but also age, disability status, veteran status, sexual orientation, religion & many other parts of ones identity. All of our employees points of view are key to our success, & inclusion is everyone's responsibility.