Medical Claims Auditor
Clover Health
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $90,000 - $110,000 per year
About the role
- Partner with Clinical, Claims, and SIU peers to review claims for billing and coding related issues on a retrospective basis that currently drive inaccurate payments to providers or indicate FWA.
- Identify control opportunities to mitigate FWA.
- Identify possible audit opportunities.
- Support annual FWA audit goals.
- Support provider conversations around FWA audit findings.
- Manage overall audit workload to ensure timely and accurate audit results.
- Work closely with senior team members and management on targeted projects and initiatives.
- Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.
Requirements
- You have 3+ years of coding and auditing experience, experience with CMS regulations preferred.
- You have a Certified Professional Coder (CPC) or other coding certification is a plus.
- You have a strong knowledge of the National Rules of Correct Codification defined by CMS in the Manual of CCI and the tables of CCI.
- You have experience working in a technology environment including claims systems, workflow management tools, Microsoft Office or Google Suite.
- You have prior experience working in health insurance; Medicare Advantage is a plus.
Benefits
- Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
- Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
- Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
- Additional Perks: 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
- And much more!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
codingauditingbillingNational Rules of Correct CodificationCMS regulationsFWA mitigationaudit management
Soft Skills
communicationtrust buildingpartnership developmentteam collaborationproject management
Certifications
Certified Professional Coder (CPC)