At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most.
We’re building a modern operating model for medical coding—one that connects Risk Adjustment, Payment Integrity, and Quality (STARS/HEDIS) into a single, data-driven system. This is a rare opportunity to work at the center of that transformation: ensuring compliant, high-quality coding today while helping design the workflows that will define how a plan of the future operates.
As part of the Office of the CEO’s AI Ops initiative, you’ll combine deep subject matter expertise with an appetite for experimentation. You’ll ensure Medicare Advantage compliance and accuracy while partnering across teams to test, measure, and scale smarter chart and claim review workflows.
As a Senior Medical Coder, you will:
- Ensure compliant coding: Apply ICD-10-CM, HCC, and MEAT standards for Medicare Advantage across risk adjustment and quality-related workflows.
- Lead chart and claim reviews: Execute prospective and retrospective reviews to validate documentation, specificity, and completeness for both revenue and quality use cases.
- Support payment integrity: Identify coding inaccuracies or overpayment risks, develop prevention and remediation workflows, and partner with regulatory audit teams.
- Advance quality measure closure: Map documentation elements to STARS and HEDIS requirements; identify and close documentation gaps.
- Leverage GenAI and advanced tools: Streamline chart reviews and coding workflows while maintaining human validation and compliance guardrails.
- QA software releases: Evaluate new tool and workflow launches from a medical coding perspective to ensure regulatory accuracy and usability.
- Educate and enable: Build feedback loops and tip sheets to improve provider documentation quality; collaborate with cross-functional teams on best practices.
- Standardize and scale: Author SOPs, audit playbooks, and process documentation that can be adopted across Revenue, Compliance, and Quality operations.
Success in this role looks like:
- Improved HCC specificity and documentation completeness across chart and claim workflows.
- Documented reductions in coding error and overpayment rates.
- High-quality QA feedback integrated into product releases and AI-assisted tools.
- Demonstrated progress toward faster, more accurate, and compliant review cycles.
- Recognized by cross-functional partners as a trusted authority on compliant coding and documentation standards.
You should get in touch if:
- Credentials: You are CPC, CCS-P, RHIT, or RHIA (required) certified; CRC preferred.
- Experience: You have 5+ years in Medicare Advantage risk adjustment, payment integrity, or quality documentation programs.
- Regulatory fluency: You have a deep understanding of CMS risk adjustment models, RADV, and STARS/HEDIS documentation requirements.
- Analytical mindset: You are able to partner with analytics to measure performance, quantify impact, and validate experimental workflows.
- Technical orientation: You are proficient with encoders and CAC tools; curious about GenAI-assisted workflows and automation.
- Process discipline: You have proven experience developing SOPs and scalable QA systems.
Benefits Overview:
- Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
- Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
- Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Additional Perks:
- Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
- Reimbursement for office setup expenses
- Monthly cell phone & internet stipend
- Remote-first culture, enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
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, perspectives, opinions, 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.
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.
A reasonable estimate of the base salary range for this role is $75,000 to $100,000. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.
#LI-Remote
