Medical Claims Auditor

Cloverhealth

Remote, US
Base: $90,000 - $100,000 usd; bonus/equity: perfor...
Remote
3+ years coding and auditing experience
Strong knowledge of cms national rules of correct codification
Experience with dme outpatient asc and physician coding
Cloverhealth is seeking a Medical Claims Auditor to join its Special Investigation Unit, focusing on identifying and investigating healthcare fraud, waste, and abuse. The position requires a strong background in coding and auditing, particularly related to Medicare coding policies, and offers a remote work environment with a range of employee benefits

Job Summary

  • The role involves partnering with Clinical and SIU peers to review claims for billing issues that drive inaccurate payments or indicate fraud.
  • Success is measured by demonstrating a strong understanding of the review process within 90 days and working autonomously on provider reviews by 6 months.
  • Clover offers a remote-first culture with comprehensive benefits including mental health resources, flexible time-off, and professional development funding.

Matching Summary

Match Score: 85

Cloverhealth is seeking a Medical Claims Auditor to join its Special Investigation Unit, focusing on identifying and investigating healthcare fraud, waste, and abuse. The position requires a strong background in coding and auditing, particularly related to Medicare coding policies, and offers a remote work environment with a range of employee benefits.

Salary

Base: $90,000 - $100,000 USD; Bonus/Equity: Performance-based bonus program and equity opportunities; Benefits: 401k matching and comprehensive health coverage

Skills & Requirements

Must-have

  • 3+ years coding and auditing experience
  • Strong knowledge of CMS National Rules of Correct Codification
  • Experience with DME Outpatient ASC and Physician coding
  • Proficiency in claims systems and workflow management tools

Nice-to-have

  • Certified Professional Coder (CPC) certification
  • Prior experience in health insurance or Medicare Advantage
  • Ability to work autonomously on provider reviews
  • Strong communication skills for building partnerships

Key Requirements

  • 3+ years of coding and auditing experience
  • Knowledge of CMS regulations and CCI tables
  • CPC certification preferred
  • Experience with technology environments and claims systems

Work Rights

Not specified

Tailored Resume

Cover Letter