Client Policy Manager

🕒 July 6

🇺🇸 United States – Remote

💵 $75k - $105k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🤝 Client Partner

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Manage client payment policies ensuring accuracy and completeness • Execute client-specific requests with internal team guidance • Primary driver of the Periodic Update analysis and industry updates • Prepare payment policy documents for presentation to the client • Review all documents and coordinate reviews with Medical Directors • Conduct research and analysis for medical policy items • Review client payment policies for accuracy • Communicate effectively with various members of the client team

🎯 Requirements

• Active professional license as a Registered Nurse (BSN preferred) or Bachelor’s Degree in Healthcare related field • Professional coder certification (CPC, CPC-H, CPC-P or CCS-P) • Minimum of 3 years clinical coding experience, preferable in a payer setting • Strong knowledge of healthcare claims payment policy and processing • Experience in claims adjudication or utilization review working for a managed care or healthcare insurance company • Familiarity with claims payment and reimbursement methodologies • Strong knowledge of CMS guidelines • Proficiency in Microsoft Office suite

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year