Job Description

At Clover Health we are committed to providing high-quality affordable and easy-to-understand healthcare plans for Americas 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 members complete health history we ensure better care at a lower costdelivering the highest value to those who need it most.

Were building a modern operating model for medical codingone 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 CEOs AI Ops initiative youll combine deep subject matter expertise with an appetite for experimentation. Youll 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 weve 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 Clovers 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 peoples lives. Diversity not only includes race and gender identity but also age disability status veteran status sexual orientation religion and many other parts of ones identity. All of our employees points of view are key to our success and inclusion is everyones 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 $75000 to $100000. Final pay is based on several factors including but not limited to internal equity market data and the applicants education work experience certifications etc.

#LI-Remote

Required Experience:

Senior IC

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