Client Policy Manager

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $78k - $106k / 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 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

🎯 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 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

🏖️ Benefits

• 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