Inpatient Coder Associate, Payment Integrity
New
C
Clover HealthHealth insurance
Remote - USAFull-TimeEntry
Salary$63,800 — $83,000 USD
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Job Details
- Experience
- 1-2 years of experience in inpatient clinical coding; preferred
- Required Skills
- Microsoft ExcelPowerPoint
Requirements
- Hold a CCS or CIC certification; required.
- Have knowledge of DRG pricing methodology; required.
- Have 1-2 years of experience in inpatient clinical coding; preferred.
- Have Medicare or Medicare Advantage payment integrity or claims operations experience; preferred.
- Have strong computer skills, including Excel and PowerPoint.
Responsibilities
- Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG-related issues prospectively and retrospectively.
- Identify overpayments to support accurate claims payments for inpatient services.
- Participate in discussions with physicians to verify the clinical rationale behind billed procedures.
- Coordinate the identification of provider DRG denials and upcoding.
- Communicate internally and externally to support accurate claims adjudication and proper provider notification.
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