Remote DRG Inpatient Coding Validator

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

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.