Clover is reinventing health insurance by working to keep people healthier.
The Provider Solutions team was created to ensure that Clover is successfully managing our contracted providers' most complex operational needs. Clover knows our members & contracted provider partners are best served when we can help collaboratively resolve through the normal course of business. The Provider Solutions team will serve as a conduit between Clover & our providers to diffuse & resolve payor-provider exacerbations. The Provider Solutions team will work with Network & with operational leaders across Clover, including, but not limited to claims, payment integrity (PI) & utilization management (UM) to optimize Clover's provider relationships.
As a Provider Solutions Associate, you will play a critical role in strengthening provider relationships through resolution of complicated provider issues. We are looking for a candidate with experience in health plan operations & a thorough understanding of the provider/payer dynamic & claims processing. Additionally the ideal candidate will be comfortable interacting with administrators & executive within provider organizations as well as within Clover with an ability to synthesize issues, create a plan for resolution & effectively communicate to all parties.
Come be at the heart of the action!
As a Provider Solutions Associate, you will:
- Be the subject matter specialist on all the Clover Health Operational area processes including: Network, Provider Data, Claims, Configuration, Payment Integrity & Finance.
- Develop procedures & lead projects to improve overall provider experience
- Research, resolve, & respond to provider-related escalations received through Salesforce & Email
- Work cross-functionally with internal teams to research & resolve standard provider escalation issues including but not limited to claims, contract, provider data/directory, configuration, payment integrity & payment issues.
- Outreach to provider groups as needed to educate providers on INN status & new Clover policies
- Assist in identifying opportunities for process & technology improvements to drive down provider abrasion
- Escalate issues to Provider Solutions Director/Manager.
- Perform other duties as assigned or directed.
You will love this job if:
- You are a great communicator & able to communicate across different teams & upward to management.
- You are a habitual strategic prioritizer, and able to identify where & when to focus your energy.
- You are a problem solver & like getting your hands dirty with the details of a gnarly problem.
- You have an insatiable curiosity which feeds an appetite to learn & teach.
You should get in touch if:
- You have 2+ years experience working in provider network, provider relations, insurance operations, or payment integrity.
- You are a Certified Professional Coder & have a working understanding of healthcare topics, such as claims processing, prior authorizations, medical billing & coding, payment integrity & physician reimbursement models.
- You have an understanding of compliance & payer requirements including Medicare regulations.
- You have the ability to interpret the contents of a medical record, an understanding of CPT & ICD-CM coding & knowledge of reimbursement practices for physician & facility services.
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.