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Inpatient Coding Validator
Clover Health. Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG-related issues prospectively and retrospectively .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical coding practices and DRG pricing methodology, ensuring accurate claims payments and regulatory compliance. Strong collaboration and communication skills are essential for effective partnerships with multidisciplinary teams and providers.
Highest-signal resume keywords
CCS CertificationCIC CertificationDRG Pricing Methodology KnowledgeInpatient Clinical Coding ExperienceClaims Operations Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical CodingClaims ReviewOverpayment IdentificationRegulatory ComplianceMedical Records Review
Soft Skills
CollaborationCommunicationTrust Building
Tools & Technologies
ExcelPowerPoint
Certifications & Qualifications
CCSCIC
Industry Keywords
DRGPayment IntegrityClaims AdjudicationInpatient ServicesMedicare
About the role
Key responsibilities & impact- Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG-related issues prospectively and retrospectively
- Proactively identify overpayments to ensure accurate claims payments on inpatient services
- Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures
- Build trust and lasting partnerships across multidisciplinary teams
- Communicate internally and externally to ensure accurate claims adjudication and proper provider notification
- Develop understanding of clinical coding practices and medical records review
- Execute clinical review workflows autonomously
- Maintain 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
- 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
- Collaboration with global teams
- Paid parental leave for all new parents