Medical Policy Director

🕒 Maio 26

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $120.000 - $145.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

⚕️ Seguro de Saúde

💳 Fintech

🤖 Inteligência Artificial

Healthcare Insurance • Fintech • Artificial Intelligence

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

• Act as a knowledgebase expert regarding the Cotiviti Medical Policy library • Gain an understanding of each client’s unique lines of business, medical policy standards and system configuration strategy to inform optimization opportunities • Analyze client data and identify new medical policy opportunities for presentation including valuation and validation of editing • Examine and select specific claim examples to utilize in a presentation to the client to support the understanding of the new medical policy • Prepare various documents and presentation materials for use during internal payment policy committee meetings and/or client meetings • Review all documents and coordinate reviews with the CMD to evaluate and validate the editing and financial impact • Confidently perform client policy presentations to highlight the facts of each rule, the data that supports the policy recommendation, the impact to claims processing, and the associated value • Successfully advocate for the adoption of new medical policies by clients to optimize the value Cotiviti offers • Participate in client meetings as required as a medical policy subject matter expert • Coordinate with the internal client team to ensure that all requested follow-up items are delivered to the client • Inspire trust and credibility with clients • Communicate effectively across various organizational levels and members of the internal and external client teams • Assist in identifying opportunities for other Cotiviti product solutions • Complete all responsibilities as outlined in the annual performance review and/or goal setting • Complete all special projects and other duties as assigned

🎯 Requisitos

• Bachelor’s Degree in a relevant field or equivalent • Professional coder certification required (CPC, CPC-A, CCA, CCS, or CCS-P), RHIT or RHIA certification a plus • Minimum of 7-10 years of work experience, preferably in sales, customer service or client management • Minimum of 5 years of experience in claim payment adjudication, medical payment/policy editing applying Medicare, Medicaid, ICD, CPT, HCPCS and other specialty society guidelines preferred • Exceptional presentation, interpersonal, verbal and written communication skills • Superior organizational skills with the ability to work in a fast-faced environment, prioritize, and manage multiple competing deadlines with minimal direction • Strong problem-solving skills and an ability to think strategically • Ability to analyze complex data and synthesize it for general consumption • Excellent computer skills in Microsoft Word, Excel, PowerPoint, and Outlook are a must • Willingness/availability to travel 10-20% is required

🏖️ Benefícios

• medical, dental, 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