Senior Medical Coder at Clover Health
San Francisco, CA, US
Clover is reinventing health insurance to keep people healthier.

The Clinical Data Operations team is a group of motivated, collaborative individuals sitting at the intersection of Clover's member care operations, data infrastructure, and software. As operational owners of incoming data on our members' health and treatment, Clinical Data Operations also manages data submissions to CMS. Come join us as we discover new opportunities to capture, clean and share data in order to provide the best possible care to our members.

As a Senior Medical Coder, you will be responsible for high quality, complete coding of Clover's Annual Wellness Visit charts to collect detailed and accurate clinical and Risk Adjustment information in accordance with CMS, and ICD.10 guidelines. You will own processes, coding changes, and productivity for the internal coding function at Clover. You will collaborate with Clover's Nurse Practitioner group to drive continuous improvement in documentation. You will consult with Clinical Data Operations and Technology team members to iterate and improve on workflows and existing tooling.

As a Senior Medical Coder, you will:

Perform chart reviews of Clover's Annual Wellness Visit charts and complete code using ICD-10 coding guidelines.
Own the accuracy and productivity of Clover's internal coding team and ensure that diagnoses are collected in accordance with Risk Adjustment and CMS regulation.
Mentor and train a Junior Medical Coder.
Work closely with Clover's Nurse Practitioner group to raise documentation issues and work with this team to improve them.
Over read Clover's vendor's coding of external provider (PCP and specialist) charts and work with the Medical Executive team to refine our vendor's coding guidelines.
Own the medical coding tools and reporting, and think critically about how these can continue to be iterated and improved upon.
Work with operations, engineering, design and data science to continue developing the tools used in the coding workflow.
Act as a proactive subject matter expert on medical coding to the rest of the organization and communicate out the latest industry and coding guideline changes.

You will love this job if:

You are meticulous, conscientious and passionate about collecting accurate information about our members in a timely manner.
You are highly dependable, thorough, and conscientious about deadlines and accuracy. Your work is organized and accurate, and you are self-monitoring.
You are process-orientated and enjoy establishing Standard Operating Procedures. You think critically about ways to improve existing processes.
You are collaborative & communicative; you enjoy working with others and don't want to work in a silo.
You're excited about motivating your team to excel and grow in their work, while also working to improve their everyday processes and tools.

You should get in touch if:

You are a certified medical coder with at least 4 years of coding experience and a current working knowledge of Hierarchal Condition Categories (HCCs), ICD-10 codes, MEAT criteria, common coding errors, and compliance requirements around accurately coding for risk adjustment across multiple specialties.
Risk Adjustment coding experience preferred.
Must have one of the following certifications (or equivalent required):
CPC (Certified Professional Coder) from accredited source (e.g. American Health Information Management Associate – AHIMA; American Academy of Professional Coders – AAPC; Practice Management Institute – PMI)
CPMA (Certified Professional Medical Auditor) from accredited source (e.g. American Health Information Management Associate – AHIMA; American Academy of Professional Coders – AAPC; Practice Management Institute – PMI)
CRC (Certified Risk Adjustment Coder)
CCS (Certified Coding Specialist)
You stay up to date on medical record coding policies and procedures ensuring compliance with regulatory standards.
You are proficient with technology including computers, word processors and spreadsheets. You are happy learning different systems as required.
You have experience in evaluating and prioritizing your own and others' work from both qualitative and data-driven perspectives. You want to exceed coding targets, and look for areas in your workflow that could be changed to streamline the process.
Your have strong interpersonal, written and verbal communication skills.

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.