Source Job

• Own the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
• Design and oversee a robust audit program that monitors adjudication system output against clinical policies, pricing, benefit rules, and provider contract terms.
• Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies and contract validation.

Clover Health aims to improve the health of its members by leveraging technology and data-driven insights to provide personalized, high-quality care. They are a mission-driven team of individuals, who are passionate about solving healthcare's most complicated problems, and strive to put members first.

• Support the enhancement and optimization of claim selection processes and tools.
• Apply clinical, coding, analytical, and reimbursement expertise to strengthen selection strategies.
• Provide coding guidance and analytical insights to inform model development and output evaluation.

Cotiviti enhances payment accuracy through data-driven solutions. They focus on improving healthcare outcomes and are an equal opportunity employer.