Role Description The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover's provider Network, Claims, and Tech teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spend. As an Inpatient Clinical Coder at Clover Health, you will play a key role ensuring that Clover is able to continue to build and scale a compliant, efficient and profitable program. You will work to ensure quality assurance standards and regulatory policy are reflected in claims processing practices. You will help drive value for every member by ensuring that Clover’s medical claims are paid accurately and recovering overpayments when they are identified. The Associate - Inpatient Coder coordinates the identification of provider DRG denials and upcoding. As an Inpatient Clinical Coder, you will: - Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers. - 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. - Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams. - Communicate effectively both internally and externally to ensure accurate claims adjudication and proper provider notification. Success in this role looks like: - By the end of your initial 90-day period, you will have demonstrated a strong understanding of clinical coding practices and medical records review, while assisting our team in areas of DRG validation. - By 6 months, you will be working autonomously to execute within our clinical review workflows and will have developed strong interpersonal relationships across the organization. - Continued success in this position anchors in on developing a deep understanding of the workflows that support our clinical review life cycle, while maintaining regulatory compliance standards. Qualifications - You hold a CCS or CIC certification; required. - Knowledge of DRG pricing methodology; required. - You have 1-2 years of experience in inpatient clinical coding; preferred. - Medicare or Medicare Advantage payment integrity or claims operations experience; preferred. - You are technologically savvy with strong computer skills in Excel and PowerPoint. Benefits - Financial Well-Being: Competitive base salary and equity opportunities, performance-based bonus program, 401k matching, and regular compensation reviews. - Physical Well-Being: Comprehensive medical, dental, and vision coverage. - Mental Well-Being: Initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. - Professional Development: Learning programs, mentorship, professional development funding, and regular performance feedback and reviews. - Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, remote-first culture, paid parental leave for all new parents, and much more! Company Description 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, perspectives, opinions, and backgrounds, who share a passion for improving people's lives.

• Own Coding Quality & Compliance • Review and validate E/M coding for behavioral health encounters in a pre-bill workflow • Ensure coding decisions align with documentation, payer guidance, and compliance best practices • Define clear standards for when revenue capture is appropriate vs when risk is too high • Establish Coding Policy & Guardrails • Develop and enforce guidelines for: • E/M level selection (MDM vs time) • Psychotherapy add-on code usage • Documentation requirements and addenda • Act as the escalation point for complex or ambiguous coding scenarios • Support internal QA and calibration to maintain consistency over time • Partner Cross-Functionally • Collaborate with Product and Engineering to operationalize coding rules within Brellium's platform • Provide feedback on automated coding logic and edge cases • Support customer-facing teams in compliance-sensitive discussions when needed • Improve Systems at Scale • Identify patterns in coding risk or opportunity across large datasets • Help standardize best-in-class coding workflows across customer organizations • Contribute to training, documentation, and internal playbooks as the program scales

• Provide accurate and timely revenue cycle and account management services to OBS member clients. • Contribute to OCHIN’s key performance indicators by identifying and resolving claims issues. • Maintain compliance with payer requirements. • Engage in continuous process improvement. • Manage self-pay accounts and customer inquiries. • Handle daily claims production including printing, mailing, and preparing documentation for clean claim submission.

• Codes and abstracts professional fee hospital services performed by SLPG physicians from medical records according to ICD-9/ICD-10, CPT-4, HCPCS II, and CMS guidelines. • Utilizes 3M Encoder for validation of RVUs and CPT-4 procedure unbundling. • Maintains a 95% coding accuracy rate as measured through quality reviews. • Performs data entry of abstracted physician information into specialty-specific databases. • Conducts educational sessions to the medical staff for coding and documentation compliance.