Remote DRG Inpatient Coding Validator

Clover Health; United States; Remote; USD 76,000 - 99,000; Full time

Benefits offered by this job

Equity opportunities

401k matching

No-Meeting Fridays

Remote-first culture

Medical, dental, vision coverage

Job summary

Clover Health is seeking a DRG Inpatient Coding Validator to ensure accurate claim payments and robust DRG validation. You will collaborate across Clinical, Claims, and Payment Integrity teams, review inpatient codes, and identify overpayments to protect the unit’s compliance and profitability.

The ideal candidate holds CCS or CIC, has at least 1 year of inpatient coding experience, and is proficient with Excel and PowerPoint.

Qualifications

• CCS or CIC certification is required.
• At least 1 year of direct inpatient coding experience.
• Knowledge of DRG pricing methodology is preferred.
• Experience with Medicare or Medicare Advantage inpatient claims in payment integrity or claims operations is a plus.

Responsibilities

• Review claims for DRG-related issues on a prospective and retrospective basis.
• Identify overpayments to ensure accurate inpatient payments.
• Discuss clinical rationale behind billed procedures with MDs.
• Communicate effectively to support accurate claims adjudication and provider notification.
• Develop strong relationships across cross-functional teams.

Skills

Inpatient coding

Excel

PowerPoint

Communication

Education

CCS or CIC certification

Tools

Excel

PowerPoint

Job description

Clover Health is seeking a DRG Inpatient Coding Validator to ensure accurate claim payments and robust DRG validation. You will collaborate across Clinical, Claims, and Payment Integrity teams, review inpatient codes, and identify overpayments to protect the unit’s compliance and profitability.

The ideal candidate holds CCS or CIC, has at least 1 year of inpatient coding experience, and is proficient with Excel and PowerPoint.