Associate, Payment Integrity

Clover is reinventing health insurance by working to keep people healthier.
The Payment Integrity team is a motivated, collaborative team sitting at the intersection of Clover's provider relationship operations, data infrastructure, and software. The Payment Integrity team ensures that Clover pays claims in a fair, transparent, compliant, and medically justified manner. Come join us as we discover new opportunities to improve the financial health of Clover while strengthening provider relationships and building a better healthcare system.
As an Associate for Payment Integrity Vendor Management at Clover Health, you will be responsible for the management of cost containment vendors. You will be responsible for ensuring adherence to service-level agreements and compliance with Clover's internal policies and procedures, while maximizing the return on investment driven by each vendor.
As an Associate Payment Integrity, you will:

• Oversee day-to-day operations of Clover's cost containment vendors. Serve as point-of-contact between external vendors and various operations teams within Clover.
• Monitor, evaluate, and manage overpayment inventory work queues to ensure for findings accuracy, adherence to SLA's, and compliance with Clover P&P's. Review and approve vendor overpayment identifications prior to pursuit.
• Identify, research, and resolve complex and escalated claim payment issues originating from vendor findings.
• Independently prepare adhoc analyses of various vendor initiatives, trends, and opportunities through the use of spreadsheets and other software used by Clover.
• Manage workflows,process vendor identifications from quality review through recovery, and address vendor disputes with a focus on developing efficiencies for future growth.
• Contribute to the ongoing development of desk level procedures and assist with documentation of future vendor initiatives.
• Handle other duties as assigned.

You will love this job if:

• You want to make an impact. You thrive off of helping others, and want your work to make a difference in our members' lives.
• You are a team player. You enjoy partnering with others, and want to work collaboratively to find new solutions.
• You are a strong communicator. You have strong verbal and written communication skills that foster trust, knowledge sharing, and progress.
• You are detail-oriented. You pay attention to the small things, while understanding how they fit into the bigger picture.
• You have strong organizational skills. You have the ability to mult-task and deliver results for various responsibilities.
• You are motivated to learn. There is no shortage of technical, clinical, and operational skills to learn at Clover.
• You are curious. You like to do research when you don't know an answer. You ask the hard questions and you don't sweep problems under the rug.

You should get in touch if:

• You hold a BA/BS degree or equivalent experience along with 2+ years of experience in the healthcare industry, with deep exposure to Payment Integrity and Medicare Advantage.
• You have 2+ years of experience billing, coding, processing, and/or auditing claims along with knowledge of correct coding guidelines (CPT, HCPCS, DRG, and ICD 9/10) and reimbursement methodologies (FFS/professional, APC, DRG, etc.). Coding certification through AAPC or AHIMA a plus.
• You are technologically savvy with strong computer skills with an emphasis on Excel and/or Google Sheets,Access, Visio, PowerPoint and basic knowledge of SQL. Knowledge of statistical methods used in the evaluation of healthcare claims data preferred.
• You have a working knowledge of CMS rules and regulations.
• You have experience in vendor management or external business partners.

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Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover's inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one's identity. All of our employee's points of view are key to our success, and inclusion is everyone's responsibility.