Medical Policy Director

🕒 4 days ago

🇺🇸 United States – Remote

💵 $120k - $145k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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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

• Act as a knowledgebase expert regarding the Cotiviti Medical Policy library • Gain an understanding of each client’s unique lines of business, medical policy standards and system configuration strategy to inform optimization opportunities • Analyze client data and identify new medical policy opportunities for presentation including valuation and validation of editing • Examine and select specific claim examples to utilize in a presentation to the client to support the understanding of the new medical policy • Prepare various documents and presentation materials for use during internal payment policy committee meetings and/or client meetings • Review all documents and coordinate reviews with the CMD to evaluate and validate the editing and financial impact • Confidently perform client policy presentations to highlight the facts of each rule, the data that supports the policy recommendation, the impact to claims processing, and the associated value • Successfully advocate for the adoption of new medical policies by clients to optimize the value Cotiviti offers • Participate in client meetings as required as a medical policy subject matter expert • Coordinate with the internal client team to ensure that all requested follow-up items are delivered to the client • Inspire trust and credibility with clients • Communicate effectively across various organizational levels and members of the internal and external client teams • Assist in identifying opportunities for other Cotiviti product solutions • Complete all responsibilities as outlined in the annual performance review and/or goal setting • Complete all special projects and other duties as assigned

🎯 Requirements

• Bachelor’s Degree in a relevant field or equivalent • Professional coder certification required (CPC, CPC-A, CCA, CCS, or CCS-P), RHIT or RHIA certification a plus • Minimum of 7-10 years of work experience, preferably in sales, customer service or client management • Minimum of 5 years of experience in claim payment adjudication, medical payment/policy editing applying Medicare, Medicaid, ICD, CPT, HCPCS and other specialty society guidelines preferred • Health plan, managed care or health insurance experience preferred • Exceptional presentation, interpersonal, verbal and written communication skills • Superior organizational skills with the ability to work in a fast-faced environment, prioritize, and manage multiple competing deadlines with minimal direction • Strong problem-solving skills and an ability to think strategically • Ability to analyze complex data and synthesize it for general consumption • Demonstrated strategy and analytical thinking skills, with the ability to effectively communicate conclusions and recommendations to diverse audiences • Excellent computer skills in Microsoft Word, Excel, PowerPoint, and Outlook are a must • Willingness/availability to travel 10-20% is required

🏖️ 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