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Clover Health · 1 month ago

Senior Medical Coder

United States

Full-time

Remote

Mid, Senior Level

$75K/yr - $100K/yr

5+ years exp

Clover Health is committed to providing high-quality healthcare plans for America’s seniors while leveraging data and technology. As a Senior Medical Coder, you will ensure compliant coding for Medicare Advantage, lead chart and claim reviews, and support payment integrity while collaborating across teams to enhance documentation quality.

Health CareHealth InsuranceHospitalMedical

Responsibilities

Ensure compliant coding: Apply ICD-10-CM, HCC, and MEAT standards for Medicare Advantage across risk adjustment and quality-related workflows

Lead chart and claim reviews: Execute prospective and retrospective reviews to validate documentation, specificity, and completeness for both revenue and quality use cases

Support payment integrity: Identify coding inaccuracies or overpayment risks, develop prevention and remediation workflows, and partner with regulatory audit teams

Advance quality measure closure: Map documentation elements to STARS and HEDIS requirements; identify and close documentation gaps

Leverage GenAI and advanced tools: Streamline chart reviews and coding workflows while maintaining human validation and compliance guardrails

QA software releases: Evaluate new tool and workflow launches from a medical coding perspective to ensure regulatory accuracy and usability

Educate and enable: Build feedback loops and tip sheets to improve provider documentation quality; collaborate with cross-functional teams on best practices

Standardize and scale: Author SOPs, audit playbooks, and process documentation that can be adopted across Revenue, Compliance, and Quality operations

Qualification

ICD-10-CM codingHCC standardsMedicare Advantage complianceCPC certificationCMS risk adjustmentAnalytical skillsEncoder proficiencyProcess disciplineCollaboration

Required

You are CPC, CCS-P, RHIT, or RHIA (required) certified

5+ years in Medicare Advantage risk adjustment, payment integrity, or quality documentation programs

Deep understanding of CMS risk adjustment models, RADV, and STARS/HEDIS documentation requirements

Ability to partner with analytics to measure performance, quantify impact, and validate experimental workflows

Proficient with encoders and CAC tools; curious about GenAI-assisted workflows and automation

Proven experience developing SOPs and scalable QA systems

Preferred

CRC preferred

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.

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.

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!