Risk Adjustment Coding Senior Associate at Clover Health

Clover is reinventing health insurance by working to keep people healthier.

The Risk Adjustment team is a group of dedicated, hard-working, enthusiastic individuals working at the heart of Clover’s Risk Adjustment operations. This team maintains the business function of any Risk Adjustment related activities, including medical record retrieval, maintenance and storage of medical records in Document Inventory Tool (central repository), medical coding, and RAPS/EDPS file submissions. The team also works on projects to improve the efficiency and accuracy of its internal operations. The success of Risk Adjustment  operations relies on collaboration with internal stakeholders such as: Engineering, Product, and Provider Relations.  

As a Risk Adjustment Coding Senior Associate at Clover you will play an active role in leading continuous process improvement initiatives for HCC operations with a strict focus on coding, education and quality assurance.   We are looking for someone with strong experience in roles that intersect both technology and operations (previous experience in Medicare Risk Adjustment is a required) and who has a strong conviction that health insurance can and should be better.

As a Risk Adjustment Coding Senior Associate, you will:

  • Assist and provide suggestions in the design and implementation of a comprehensive risk adjustment and coding reporting program; including the identification of opportunities for complete capture of patients’ current risk.
  • Accurately assigning ICD codes for diagnostic and procedure codes for all levels of care, with specific experience with HCC coding as it relates to Medicare Advantage program rules.
  • Partner with the Senior Manager, collaborating closely with external vendors to provide recommendations in the build of process improvements which will lower costs.
  • Be a  key contributor and partner in the oversight of the coding operations for risk adjustment that will encompass coding vendor oversight to ensure quality and productivity measures are being met.
  • Maintain and update internal coding guidelines to meet all CMS requirements relating to: risk adjustment model changes, AHA coding clinic updates, diagnosis code changes, etc.
  • Escalates recommendations on development or enhancement of coder workflows and processes.
  • Assess how the workflows affect related operations management, success measures, and identification of value-add and opportunities.
  • Conduct training sessions and job shadowing of vendor coding teams to identify coding efficiencies, software improvements, clinical documentation improvement opportunities, etc.
  • Create alignment between coding compliance and product development.
  • Work closely with internal stakeholders on CDI initiatives and/or opportunities.

 You will love this job if:

  • You enjoy translating medical terminology into diagnostic codes. 
  • You are a true collaborator and believe in working cohesively with other departments to move things forward.
  • You feel a deep sense of ownership and accountability for clinical documentation improvement and educating others the nuances around risk adjustment coding. 
  • You are excited to innovate and improve core processes of health insurance - many of which haven't changed in decades.
  • You thrive in fast-paced, ambiguous environments and execute with speed and a bias towards action.

 You should get in touch if:

  • You have 5+ years of coding experience, with at least 3+ years experience in Medicare Advantage Risk Adjustment HCC coding. 
  • A current coding certification recognized by AAPC, AHIMA or other nationally recognized coding certification, preferred to hold a CRC certification.
  • You have the ability to partner in the development, management and operationalizing processes and workflows to maximize efficiencies. 
  • You understand how critical Risk Adjustment operations are and seek to drive improvement and innovation in this area.
  • Demonstrated knowledge in leadership, collaboration, and performance/process improvement.

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.