Policy Design Specialist – Level I

🕒 April 4

🇺🇸 United States – Remote

💵 $23 - $25 / hour

⏰ Full Time

🟢 Junior

✍️ Designer

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Implement new policies and update existing policies for clients to ensure the policy is editing in accordance with the industry and per the client’s expectation • Write and design client requested policies from scratch, translating client expectations into Cotiviti guidelines to ensure appropriate configuration • Execute projects requests, design work orders, and actively monitor queues to ensure all requests are completed by the desired completion date • Balance multiple priorities and manage projects deliverables for two or more healthcare clients • Proactively assist on other client accounts where needed • Provide the highest level of customer service by documenting and staying current regarding all client sensitivities and configuration needs • Investigate situations where configuration updates conflict with client customizations or needs • Meet daily and monthly production and quality targets; maintaining an exemplary level of accuracy in all work; ensuring that the capture and completion of assigned projects are audited and that corrections are made where needed • Perform regular quality checks to ensure accuracy for all a client’s policy set by analyzing quality reports and troubleshoot results, determining root cause(s) and promptly resolving • Perform Peer Review responsibilities by providing feedback to peers assisting in achieving department quality goals • Receive peer feedback, identifying any trends and proposing concise solutions to minimize error rate • Resolve testing issues and conflicts related to policy configuration updates and policy overlaps • Analyze pre and post client claim data to ensure appropriate claim editing • Participate in client presentations by providing configuration expertise and capturing client decisions • Coordinates and manages post-client presentation activities • Maintain detailed and up to date knowledge of internal applications, actively participating in all trainings and software release meetings • Communicate effectively and timely with upstream functional areas to resolve issues

🎯 Requirements

• Bachelor's Degree preferred or equivalent work experience • Coding or HIM credential preferred (RHIA, CPC, etc.) • 1 or more years of experience / understanding of: medical terminology, anatomy and physiology • Health plan payment policy experience or internal company payment policy experience • 2 or more years of experience in claim payment/adjudication, medical payment policy, experience in hospital administration, or multispecialty experience and exposure to professional and facility claims (or equivalent Cotiviti experience) • Proficient with Microsoft Office Suite (Word, Excel, Power Point) • Experience with SQL preferred • Ability to work well in a team environment or independently and perform well under pressure • Strong analytical and problem-solving skills • Excellent verbal and written communication skills

🏖️ Benefits

• medical, dental, vision, disability, and 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 specific level and length of service with Cotiviti