Client Policy Manager

🕒 il y a 9 jours

🇺🇸 États-Unis – Télétravail

💵 $78 000 - $106 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

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Cotiviti

Site WebLinkedInTous les Emplois

5001 - 10000 employés

🏥 Santé

💼 Conseil

📦 Logistique

Healthcare • Consulting • Logistics

Cotiviti est une entreprise de technologie et d'analytique dans le secteur de la santé, spécialisée dans l'amélioration de l'exactitude des paiements et des performances grâce à des solutions avancées d'analytique de données. Elle collabore avec des régimes de santé, des agences gouvernementales et des prestataires de soins de santé pour fournir des insights qui améliorent la qualité et l'efficacité de la prestation de soins. Grâce à des solutions telles que l'ajustement des risques, la gestion des politiques de paiement et l'engagement des membres, Cotiviti vise à optimiser les résultats financiers et cliniques pour l'écosystème de la santé.

Description

• Manage client payment policies to ensure accuracy, currency, and completeness • Execute client-specific requests with guidance from internal teams and serve as an internal and external client team liaison • Maintain the integrity of client medical policy sets • Track client-related Medical Policy project requests • Conduct monthly reviews of Max Units and Health Plan rules • Drive Periodic Update analysis and industry updates • Identify and implement changes needed to keep client policies accurate and current • Prepare payment policy documents for client presentation • Review documents, coordinate reviews with Medical Directors, and participate in client policy meetings • Research and analyze medical policy items with guidance from the Cotiviti Client Medical Director and Content team • Review and articulate medical policies and present them for review and client acceptance • 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, apply decisions to affected policies, maintain information, and communicate outcomes • Complete Performance Plan responsibilities, special projects, and other assigned duties

🎯 Exigences

• Active professional license as a Registered Nurse (BSN preferred) or Bachelor’s Degree in 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, health plans, managed care or healthcare insurance company operations • 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 across 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

🏖️ Avantages

• 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 specific level and length of service • Remote work • Flexible scheduling to accommodate global time zones • Up to 20% travel requirement • Employer-provided benefits package