DRG Validation Auditor

🔥 16 hours ago

🇺🇸 United States – Remote

💵 $76k - $99k / year

⏰ Full Time

🟢 Junior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Clover Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

🛡️ Insurance

🤖 Artificial Intelligence

Healthcare • Insurance • Artificial Intelligence

Clover Health is a healthcare technology company helping members live their healthiest lives with our Medicare Advantage plans. Focused on seniors who have historically lacked access to affordable and high-quality healthcare, Clover aims to provide care sustainably by improving medical outcomes while simultaneously lowering avoidable costs. They leverage a proprietary software platform, the Clover Assistant, to aggregate patient data and offer real-time recommendations to healthcare providers. Their services include affordable Medicare Advantage plans, a home care program, and they manage care for Medicare Advantage members across several U. S. states.

📋 Description

• Review claims for DRG-related issues on a prospective and retrospective basis • Identify overpayments to ensure accurate inpatient claims payments • Participate in discussions with MDs to verify the clinical rationale behind billed procedures • Partner with Clinical, Claims, and Payment Integrity teams • Communicate internally and externally to support accurate claims adjudication and provider notification • Develop understanding of clinical coding practices, medical records review, DRG validation, clinical review workflows, and regulatory compliance standards

🎯 Requirements

• CCS or CIC certification; required • Knowledge of DRG pricing methodology; required • At least 1 year of direct inpatient clinical coding experience • Medicare or Medicare Advantage payment integrity or claims operations experience; preferred • Strong computer skills in Excel and PowerPoint • Technologically savvy

🏖️ Benefits

• Competitive base salary • Equity opportunities • Performance-based bonus program • 401k matching • Regular compensation reviews • Comprehensive medical, dental, and vision coverage • No-Meeting Fridays • Monthly company holidays • Mental health resources • Generous flexible time-off policy • Remote-first culture supporting collaboration and flexibility • Learning programs • Mentorship • Professional development funding • Regular performance feedback and reviews • 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

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