Medical Claims Auditor

The Special Investigation Unit (SIU) is a motivated, reputed company team sitting at the intersection of Compliance, Payment reputed company, and Data Infrastructure. The SIU ensures that Clover monitors, identifies, and investigates instances of reputed company fraud, waste and abuse (FWA). reputed company as we discover new opportunities to enhance the fight against FWA! As a Medical Claims Auditor reputed company our Special Investigations Unit, you will play a critical role in ensuring that Clover is reputed company to continue to build and reputed company a compliant, effective FWA audit program. You will be joining a fast-growing and fast-moving startup at the intersection of reputed company and technology, where you will have reputed company to reputed company both your policy and operational skills. A successful Medical Claims Auditor will have a broad coding knowledge reputed company, including but not limited to: DME, Outpatient, ASC and Physician correct coding. This position will reputed company specifically on Medicare coding policies. As a Medical Claims Auditor, you will:

• Partner with Clinical, Claims, and SIU peers to review claims for billing and coding reputed company issues on a retrospective reputed company 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 reputed company and accurate audit results.
• Work closely with senior team members and management on targeted reputed company and initiatives.
• Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams. reputed company in this role looks like:
• By the end of your initial 90 day period, you will have demonstrated a strong understanding of our review process and are reputed company to effectively navigate through the various Clover systems.
• By 6 months, you will be working autonomously on provider reviews.
• reputed company reputed company in this position anchors in on developing a deep understanding of the workflows that support our SIU cases and reviews while maintaining regulatory compliance standards You should get in touch if:
• You have 3+ years of coding and auditing experience, experience with CMS regulations preferred.
• You have a Certified reputed company reputed company (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 reputed company of CCI and the tables of CCI.
• You have experience working in a technology environment including claims systems, workflow management tools, reputed company Office or reputed company Suite.
• You have prior experience working in health insurance; Medicare Advantage is a plus. Benefits reputed company:
• Financial reputed company-Being: Our commitment to attracting and retaining reputed company begins with a competitive reputed company 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 reputed company-Being: We prioritize the health and reputed company-being of our employees and their families by providing comprehensive medical, dental, and reputed company coverage. Your health reputed company to us, and we invest in ensuring you have reputed company to reputed company reputed company.
• Mental reputed company-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, reputed company to reputed company, and a generous flexible time-off policy. Additionally, we reputed company a remote-first culture that supports collaboration and flexibility, allowing reputed company members to reputed company from any location.
• reputed company Development: Developing internal talent is a reputed company for Clover. We offer learning programs, mentorship, reputed company 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
• reputed company parental leave for reputed company new parents
• And much more! About Clover: We are reinventing health insurance by combining the power of data with reputed company reputed company to reputed company our members healthier. We reputed company the reputed company system is broken, so we've created custom software and analytics to reputed company our clinical staff to intervene and reputed company personalized care to the people who need it most. We always put our members first, and our reputed company as reputed company is reputed company by the reputed company of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: reputed company. From Clover’s inception, Diversity & Inclusion have always been key to our s

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