DRG Validation Auditor

Clover Health

. Review claims for DRG-related issues on a prospective and retrospective basis .

Posted 11/11/2026full-timeRemote • United StatesJunior💰 $76,000 - $99,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in DRG-related claims review, clinical coding practices, and regulatory compliance standards. Proficient in collaborating with clinical teams and utilizing technology for accurate claims adjudication.

Highest-signal resume keywords

CCS CertificationCIC CertificationDRG Pricing Methodology KnowledgeInpatient Clinical Coding ExperienceMedicare Payment Integrity Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical CodingClaims ReviewDRG ValidationMedical Records ReviewRegulatory ComplianceClaims Adjudication

Soft Skills

CommunicationCollaboration

Tools & Technologies

ExcelPowerPoint

Certifications & Qualifications

CCSCIC

Industry Keywords

DRGInpatient ClaimsPayment IntegrityMedicareClaims Operations

About the role

Key responsibilities & impact

Review claims for DRG-related issues on a prospective and retrospective basis
Identify overpayments to ensure accurate inpatient claims payments
Participate in discussions with MDs to verify the clinical rationale behind billed procedures
Partner with Clinical, Claims, and Payment Integrity teams
Communicate internally and externally to support accurate claims adjudication and provider notification
Develop understanding of clinical coding practices, medical records review, DRG validation, clinical review workflows, and regulatory compliance standards

Requirements

What you’ll need

CCS or CIC certification; required
Knowledge of DRG pricing methodology; required
At least 1 year of direct inpatient clinical coding experience
Medicare or Medicare Advantage payment integrity or claims operations experience; preferred
Strong computer skills in Excel and PowerPoint
Technologically savvy

Benefits

Comp & perks

Competitive base salary
Equity opportunities
Performance-based bonus program
401k matching
Regular compensation reviews
Comprehensive medical, dental, and vision coverage
No-Meeting Fridays
Monthly company holidays
Mental health resources
Generous flexible time-off policy
Remote-first culture supporting collaboration and flexibility
Learning programs
Mentorship
Professional development funding
Regular performance feedback and reviews
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