[All remote jobs](https://jobicy.com/jobs.md)[![Clover Health logo](https://jobicy.com/data/server-nyc0409/galaxy/mercury/2025/06/8d4e74b3-221.jpg)](https://jobicy.com/company/clover-health.md)[Clover Health](https://jobicy.com/company/clover-health.md) # DRG Inpatient Coding Validator AI Summary This role validates inpatient DRG coding and medical claims to identify inaccurate payments, denials, and potential overpayments. The validator partners with clinical, claims, and payment integrity teams and consults with physicians to confirm the clinical rationale for billed procedures. Key requirements include a CCS or CIC certification, DRG pricing knowledge, and at least one year of direct inpatient coding experience. Success requires strong regulatory awareness, careful medical-record review, and clear communication with internal teams and providers.[Apply for this job](#job-application)[View company](https://jobicy.com/company/clover-health.md)ShareRemote from[USA](https://jobicy.com/job-region/usa.md)SalaryUSD 76k–99k / yrDepartment[Healthcare & Medical](https://jobicy.com/categories/healthcare.md)EmploymentFull TimeExperienceSeniorPublished12 Nov 2026Apply before12 Dec 2026Listing views34Application actions1Application toolkit ## Make your next move. Prepare your resume, explore your fit, and draft a cover letter for this opportunity. Opportunity details ## About this role. 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 DRG Inpatient Coding Validator at [Clover Health](https://jobicy.com/company/clover-health.md), 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 DRG Inpatient Coding Validator, 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. You should get in touch if: * You hold a CCS or CIC certification; required. * Knowledge of DRG pricing methodology; required. * You have at least 1 year of direct inpatient clinical coding experience. * Medicare or Medicare Advantage payment integrity or claims operations experience; preferred * You are technologically savvy with strong computer skills in Excel and PowerPoint. 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. #LI-REMOTE 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](https://www.e-verify.gov/?utm_medium=search&utm_source=google&utm_campaign=everify2018&utm_content=bg_Branded_Everify_General_English_BMM_E_Verify&utm_keyword=everify) company. #LI-Remote 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. A reasonable estimate of the base salary range for this role is: $76,000—$99,000 USD Show more [Apply now >](https://jobicy.com/jobs/161575-drg-inpatient-coding-validator.md) * ![Upload CV](data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSI2NSIgaGVpZ2h0PSI2NSIgZmlsbD0ibm9uZSIgeG1sbnM6dj0iaHR0cHM6Ly92ZWN0YS5pby9uYW5vIj48ZyBjbGlwLXBhdGg9InVybCgjQSkiPjxwYXRoIGQ9Ik0wIDBINjVWNjVIMFYwWiIgZmlsbD0iIzAyOWFlYiIvPjxnIGZpbGw9IiNmZmYiIHN0cm9rZT0iI2ZmZiIgc3Ryb2tlLXdpZHRoPSIyIj48cGF0aCBkPSJNMzMuMDQ5IDE1LjQ1NGExLjQzIDEuNDMgMCAwIDAtMi4wOTcgMGwtNy41NzkgOC4xNDdhMS4zOCAxLjM4IDAgMCAwIC4wOSAxLjk3MyAxLjQ0IDEuNDQgMCAwIDAgMi4wMDgtLjA4OGw1LjEwOS01LjQ5MnYyMC42MWExLjQxIDEuNDEgMCAwIDAgMS40MjEgMS4zOTdjLjc4NSAwIDEuNDIxLS42MjUgMS40MjEtMS4zOTd2LTIwLjYxbDUuMTA5IDUuNDkyYTEuNDQgMS40NCAwIDAgMCAyLjAwOC4wODggMS4zOCAxLjM4IDAgMCAwIC4wOS0xLjk3M2wtNy41NzktOC4xNDZ6TTE2Ljc2OSAzOC40YzAtLjc3My0uNjItMS40LTEuMzg1LTEuNFMxNCAzNy42MjcgMTQgMzguNHYuMTAybC4yMTUgNi4yMjljLjIyMyAxLjY4LjcwMSAzLjA5NSAxLjgxMyA0LjIxOHMyLjUxIDEuNjA3IDQuMTcyIDEuODMzYzEuNi4yMTggMy42MzYuMjE4IDYuMTYuMjE4aDExLjI4bDYuMTYtLjIxOGMxLjY2Mi0uMjI2IDMuMDYxLS43MDkgNC4xNzItMS44MzNzMS41ODktMi41MzggMS44MTMtNC4yMThDNTAgNDMuMTEzIDUwIDQxLjA1NSA1MCAzOC41MDNWMzguNGMwLS43NzMtLjYyLTEuNC0xLjM4NS0xLjRzLTEuMzg1LjYyNy0xLjM4NSAxLjRsLS4xOSA1Ljk1OGMtLjE4MiAxLjM3LS41MTUgMi4wOTUtMS4wMjYgMi42MTJzLTEuMjI4Ljg1My0yLjU4MyAxLjAzOGMtMS4zOTUuMTktMy4yNDMuMTkzLTUuODkzLjE5M0gyNi40NjJjLTIuNjUgMC00LjQ5OC0uMDAzLTUuODkzLS4xOTMtMS4zNTUtLjE4NC0yLjA3Mi0uNTIxLTIuNTgzLTEuMDM4cy0uODQ0LTEuMjQyLTEuMDI2LTIuNjEyYy0uMTg3LTEuNDEtLjE5MS0zLjI3OS0uMTkxLTUuOTU4eiIvPjwvZz48L2c+PGRlZnM+PGNsaXBQYXRoIGlkPSJBIj48cGF0aCBmaWxsPSIjZmZmIiBkPSJNMCAwaDY1djY1SDB6Ii8+PC9jbGlwUGF0aD48L2RlZnM+PC9zdmc+) ### Upload your resume now To unlock remote work opportunities and be discovered by global employers. This job listing has been manually reviewed by the Jobicy Trust & Safety Team for compliance with our posting guidelines, including verification of the company's legitimacy, accuracy of job details, clarity of remote work policy, and absence of misleading or fraudulent content. ## Role DNA A quick view of the complexity, pace, ownership and collaboration implied by the job description. ### Job Complexity 4/5EasyHard ### Pace & Pressure 4/5RelaxedFast-paced ### Autonomy Level 4/5GuidedFull ownership ### Communication Load 4/5IndependentCollaborative AI insightThe position requires specialized inpatient coding credentials, detailed DRG expertise, and accurate interpretation of clinical documentation. Errors can affect claims payments, compliance, provider relationships, and recovery of overpayments. ## Salary analysis Estimated compensation compared with the broader US market for similar roles. Estimated job median (per year)Highly competitive$87,500US market range (per year)$70k–$98k0$107.80k AI insightThe yearly pay period is inferred from the job context; it was not explicitly stated by the employer. The employer discloses a base salary range of $76,000 to $99,000 USD. The posting does not explicitly state the pay cadence, so yearly pay is inferred from the amount, US location, full-time context, and professional healthcare coding role. The midpoint is $87,500 per year; the estimated US market range is $70,000 to $98,000 per year. ## Core skills Skills and capabilities most closely associated with this opportunity. [Inpatient coding](https://jobicy.com/jobs?search_keywords=Inpatient%20coding.md)[DRG validation](https://jobicy.com/jobs?search_keywords=DRG%20validation.md)[Medical record review](https://jobicy.com/jobs?search_keywords=Medical%20record%20review.md)[Claims adjudication](https://jobicy.com/jobs?search_keywords=Claims%20adjudication.md)[Payment integrity](https://jobicy.com/jobs?search_keywords=Payment%20integrity.md)[Medicare Advantage](https://jobicy.com/jobs?search_keywords=Medicare%20Advantage.md)[Clinical documentation review](https://jobicy.com/jobs?search_keywords=Clinical%20documentation%20review.md)[Regulatory compliance](https://jobicy.com/jobs?search_keywords=Regulatory%20compliance.md)[Overpayment recovery](https://jobicy.com/jobs?search_keywords=Overpayment%20recovery.md)[Provider communication](https://jobicy.com/jobs?search_keywords=Provider%20communication.md)[Excel](https://jobicy.com/jobs?search_keywords=Excel.md)[PowerPoint](https://jobicy.com/jobs?search_keywords=PowerPoint.md) Sample interview questionsHow do you approach a DRG validation review when the billed code appears unsupported?I review the complete medical record, including the history and physical, progress notes, operative reports, discharge summary, and diagnostic results. I compare the documented clinical evidence with coding guidelines and DRG criteria, then clearly document the rationale for any finding or query. What is your experience with identifying inpatient overpayments? I look for coding inaccuracies, unsupported diagnoses or procedures, DRG assignment issues, duplicate payments, and mismatches between clinical documentation and billed services. I prioritize findings with clear evidence, quantify the payment impact, and communicate the result through established claims and provider-notification workflows. How would you handle a disagreement with a physician about the clinical rationale for a billed procedure? I would approach the conversation respectfully and focus on objective documentation, applicable coding guidance, and the clinical facts in the record. My goal would be to understand the physician's perspective, resolve any ambiguity, and ensure the final decision is consistent, compliant, and well supported. How do Medicare and Medicare Advantage knowledge support this role? These programs have specific payment, coverage, compliance, and documentation requirements that directly affect claim accuracy. Understanding those rules helps me assess DRG-related findings appropriately, recognize payment-integrity risks, and support defensible recovery or denial decisions. How do you maintain quality while managing a high volume of claim reviews? I use a structured review checklist, prioritize cases by financial and compliance risk, and document findings consistently. I also track recurring error patterns, use reporting tools to organize work, and seek calibration with peers or clinical stakeholders when guidance is unclear. Next step ## Apply now. Follow the employer’s application method and review Jobicy’s safety guidance before sharing personal information. 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