DRG Inpatient Coding Validator (Fully Remote)

Clover Health; United States; Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

ESPP

Office setup reimbursement

Cell/internet stipend

Paid parental leave

Remote-first culture

Job summary

Clover Health seeks a Healthcare Coding Specialist skilled in DRG-based inpatient reviews. You will partner with Clinical, Claims and Payment Integrity teams to review DRG-related issues and identify overpayments, ensuring accurate inpatient payments.

You must hold a CCS or CIC certification, have DRG pricing knowledge, and at least 1 year of direct inpatient coding experience. The role supports a remote-first culture with comprehensive benefits.

Qualifications

• CCS or CIC certification required.
• Knowledge of DRG pricing methodology required.
• At least 1 year of direct inpatient clinical coding experience.

Responsibilities

• Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis.
• Proactively identify overpayments to ensure accurate claims payments on inpatient services.
• Participate in collaborative discussions with MDs to verify clinical rationale behind billed procedures.

Skills

Clinical coding

DRG knowledge

Interpersonal communication

Education

CCS or CIC certification

Job description

• Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis.
• Proactively identify overpayments to ensure accurate claims payments on inpatient services.
• Participate in collaborative discussions with MDs to verify clinical rationale behind billed procedures.

Qualifications:

• Hold a CCS or CIC certification; required.
• Knowledge of DRG pricing methodology; required.
• At least 1 year of direct inpatient clinical coding experience.

Success Metrics:

• Within 90 days: demonstrate strong understanding of clinical coding practices and medical records review.
• By 6 months: work autonomously in clinical review workflows and develop strong interpersonal relationships.
• Continued success: deep understanding of workflows supporting clinical review lifecycle and regulatory compliance.
• Financial Well-Being: competitive salary, equity, performance bonus, 401k matching.
• Physical Well-Being: comprehensive medical, dental, and vision coverage.
• Mental Well-Being: No-Meeting Fridays, monthly holidays, mental health resources, flexible time-off, remote-first culture.
• Professional Development: learning programs, mentorship, funding, performance feedback.
• Additional Perks: ESPP, office setup reimbursement, cell/internet stipend, paid parental leave.

Clover Health

Clover Health is reinventing health insurance by combining data with human empathy to keep members healthier. The company has a diverse team of mission-driven individuals who prioritize inclusion and collaboration.