Client Policy Manager

🕒 Agosto 19

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $78.000 - $106.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

Cotiviti é uma empresa de tecnologia e análise em saúde que se especializa em melhorar a precisão e o desempenho dos pagamentos por meio de soluções avançadas de análise de dados. Eles se associam a planos de saúde, agências governamentais e provedores de serviços de saúde para fornecer insights que aprimoram a qualidade e a eficiência na prestação de cuidados. Com soluções como ajuste de risco, gerenciamento de políticas de pagamento e engajamento de membros, a Cotiviti busca otimizar os resultados financeiros e clínicos para o ecossistema de saúde.

Descrição

• Manage client payment policies to ensure they are accurate, up-to-date and complete • Execute client-specific requests with guidance from the internal team and act as the internal and external client team liaison • Maintain the integrity of the client’s medical policy set • Track client-related medical policy project requests and conduct monthly reviews of Max Units and Health Plan rules • Drive Periodic Update analysis and industry updates • Review and identify changes needed to client policies • Prepare payment policy documents for client presentation • Coordinate document reviews with Medical Directors and participate in client policy meetings • Conduct medical policy research and analysis with guidance from Cotiviti Client Medical Director and Content • Review client payment policies for accuracy and timeliness • Clearly understand and articulate medical policies and present them to the Cotiviti Client Medical Director for review and client acceptance • Provide direction regarding client understanding of medical policies • Document and maintain client medical policy sensitivities and nuances in the Client Profile Workbook • Communicate with internal and external client-team members • Perform multifaceted data and report analytics • Apply project management principles to initiate, create and manage projects • Review and analyze client inquiries, determine affected policies, maintain information and communicate decisions to clients • Complete annual Performance Plan responsibilities, special projects and other assigned duties

🎯 Requisitos

• Active professional license as a Registered Nurse (BSN preferred) or Bachelor’s Degree in a Healthcare-related field or relative experience • Professional coder certification (CPC, CPC-H, CPC-P or CCS-P) • Minimum of 3 years clinical coding experience, preferably in a payer setting • Strong knowledge of healthcare claims payment policy and processing, including CMS, Medicaid, ICD, CPT, HCPCS and specialty society standards • Experience in claims adjudication or utilization review for a managed care or healthcare insurance company • Familiarity with claims payment and reimbursement methodologies • Experience in customer service or client management in a healthcare setting • Strong knowledge of CMS guidelines • Experience with health plans, managed care or healthcare insurance companies • Prior experience developing medical payment policy edits • Proficiency in Microsoft Office suite • Demonstrated problem-solving skills • Ability to properly handle confidential information • Ability to work independently and collaboratively in a fast-paced, demanding environment • Ability to analyze data and synthesize it for customer and internal consumption • Effective verbal and written communication and interpersonal skills • Ability to manage timelines and multiple projects, prioritize and meet deadlines • Flexibility and willingness to participate in an international organization’s work processes, including conference calls accommodating global time zones • Must be able to perform duties with or without reasonable accommodation • Must be able to lift up to 20 lbs without assistance • Must be able to sit and use a computer keyboard for extended periods • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance

🏖️ Benefícios

• Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service • Remote work • Up to 20% travel requirement • Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance provided by the employee