Client Policy Manager

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $75k - $105k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

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

• 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 client medical policy sets, including Medical Policy project requests, monthly Max Units reviews, and Health Plan rules reviews • Drive Periodic Update analysis and industry updates • Review and identify changes needed to maintain accurate medical payment policies • Prepare payment policy documents for client presentation • Coordinate document reviews with Medical Directors and participate in client policy meetings • Research and analyze medical policy items with guidance from Cotiviti Client Medical Director and Content • Review, articulate, present, and explain client medical policies for review and 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 • Initiate, create, and manage projects using project management principles • Review and analyze client inquiries, determine affected policies, maintain information, and communicate with clients • Complete annual Performance Plan responsibilities, special projects, and other assigned duties

🎯 Requirements

• 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 of 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 • Customer service or client-management experience in a healthcare setting • Ability to understand and articulate medical policies • Strong knowledge of CMS guidelines • Health plan, managed-care, or healthcare-insurance-company experience • 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 environment • Ability to analyze data and synthesize it for customers and internal stakeholders • Effective verbal, written, and interpersonal communication skills • Ability to manage timelines and multiple projects, prioritize, and meet deadlines • Flexibility to participate in an international organization’s work processes, including conference calls across global time zones • Ability to perform duties with or without reasonable accommodation • Ability to travel up to 20% • Ability to lift up to 20 lbs without assistance • Ability to work after hours and/or weekends when necessary for major deliverables or deadlines • Ability to sit and use a computer keyboard for extended periods • Ability to provide a dedicated, secure work area • Ability to provide high-speed internet access/connectivity and maintain an office setup • Must live in the continental United States

🏖️ 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 • Remote work arrangement • Equal employment opportunity