Senior Medical Coder

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Clover Health

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Clover Health (Nasdaq: CLOV) is a physician enablement company focused on seniors who have historically lacked access to affordable, high-quality healthcareWe aim to provide great care, in a sustainable way, by having a business model built around improving medical outcomes while lowering avoidable costs. We do this while taking a holistic approach to understanding the health needs and social risk factors of those under our care. This strategy is underpinned by our proprietary software platform, the Clover Assistant, which is designed to aggregate patient data from across the health ecosystem to support clinical decision-making by presenting physicians and other providers with real-time, personalized recommendations at the point of care.Making care more accessible is at the heart of our business, and we believe patients should have the freedom to choose their doctors. We offer affordable Medicare Advantage plans with extensive benefits, provide primary care physicians with the Clover Assistant, and also make comprehensive home-based care available via the Clover Home Care program.With our corporate headquarters in Nashville, Clover’s workforce is distributed around the U.S. and also includes a team of world-class technologists based in Hong Kong. We manage care for Medicare Advantage members in Alabama, Arizona, Georgia, Mississippi, New Jersey, Pennsylvania, South Carolina, Tennessee, and Texas.We are hiring software engineers, data scientists, designers and product folks who can help us understand our members’ wellness and steer them clear of any health risks down the road.If you’re a passionate person and interested in changing healthcare for the better, then Clover Health may just be the place for you.

501 - 1000 employees

📋 Description

• Ensure compliant coding: Apply ICD-10-CM, HCC, and MEAT standards for Medicare Advantage across risk adjustment and quality-related workflows. • Lead chart and claim reviews: Execute prospective and retrospective reviews to validate documentation, specificity, and completeness for both revenue and quality use cases. • Support payment integrity: Identify coding inaccuracies or overpayment risks, develop prevention and remediation workflows, and partner with regulatory audit teams. • Advance quality measure closure: Map documentation elements to STARS and HEDIS requirements; identify and close documentation gaps. • Leverage GenAI and advanced tools: Streamline chart reviews and coding workflows while maintaining human validation and compliance guardrails. • QA software releases: Evaluate new tool and workflow launches from a medical coding perspective to ensure regulatory accuracy and usability. • Educate and enable: Build feedback loops and tip sheets to improve provider documentation quality; collaborate with cross-functional teams on best practices. • Standardize and scale: Author SOPs, audit playbooks, and process documentation that can be adopted across Revenue, Compliance, and Quality operations.

🎯 Requirements

• Credentials: You are CPC, CCS-P, RHIT, or RHIA (required) certified; CRC preferred. • Experience: You have 5+ years in Medicare Advantage risk adjustment, payment integrity, or quality documentation programs. • Regulatory fluency: You have a deep understanding of CMS risk adjustment models, RADV, and STARS/HEDIS documentation requirements. • Analytical mindset: You are able to partner with analytics to measure performance, quantify impact, and validate experimental workflows. • Technical orientation: You are proficient with encoders and CAC tools; curious about GenAI-assisted workflows and automation. • Process discipline: You have proven experience developing SOPs and scalable QA systems.

🏖️ Benefits

• Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions. • Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare. • Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location. • Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews. • Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities. • Reimbursement for office setup expenses. • Monthly cell phone & internet stipend. • Remote-first culture, enabling collaboration with global teams. • Paid parental leave for all new parents. • And much more!