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Payment Integrity Team:
- Ensures Clover pays claims accurately.
- Focuses on reducing inappropriate medical spend.
- Plays a key role in program development.
As a Senior Auditor:
- Lead prospective claim review audits related to clinical DRG coding compliance.
- Ensure payment integrity programs stay compliant with internal and Medicare guidelines.
- Identify potential program efficiencies/opportunities.
Success in the role:
- Demonstrate a strong understanding of the prepay clinical claim review audit process.
- Oversee prepay clinical review workflows to ensure accuracy and adherence with regulatory guidelines.
- Adapt to evolving priorities and ad hoc requests.
Clover Health
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep their members healthier. They've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most; they are passionate and mission-driven individuals.