Client Policy Manager

Cotiviti•Remote,

3d•$78,000 - $106,000•Remote

About The Position

The Client Policy Manager I manages client payment policies by ensuring client’s payment policy is accurate, up-to-date, and complete; executes client-specific requests with guidance from internal team and acts as the internal and external client team liaison. This position is client facing and requires a commitment to superior client service. This role is primarily responsible for the integrity of the client’s medical policy set, including awareness of all client-related Medical Policy project requests, monthly review of Max Units, and review of Health Plan rules.

Requirements

Active professional license as a Registered Nurse 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, preferable in a payer setting
Strong knowledge of healthcare claims payment policy and processing, specifically, CMS, Medicaid, ICD, CPT, HCPCS and other specialty society
Experience in claims adjudication or utilization review working for a managed care or healthcare insurance company
Familiarity with claims payment and reimbursement methodologies
Experience in customer service or client management with a strong focus on healthcare setting
Strong Knowledge of CMS guidelines
Prior experience in developing medical payment policy edits
Proficiency in Microsoft Office suite
Demonstrated problem-solving skills
Ability to work well both independently and collaboratively
Ability to analyze data and synthesize it for customer and internal consumption
Effective verbal and written communication, and interpersonal skills
Effective at managing timelines and multiple projects with the ability to prioritize and meet deadlines

Nice To Haves

BSN preferred

Responsibilities

Primarily responsible for the integrity of the client’s medical policy set
Primary driver of the Periodic Update analysis and industry updates
Prepare payment policy documents for presentation to the client
Coordinate reviews with Medical Directors and participate in client policy meetings
Conduct research and analysis for medical policy items
Review client payment policies for accuracy and complete reviews on a timely basis
Add value to medical policy content by participating and offering knowledge proactively
Document and maintain client medical policy sensitivities and nuances in the Client Profile Workbook
Communicate effectively with internal and external client teams
Perform multi-faceted data and report analytics
Apply project management principles in managing projects
Review and analyze client inquiries for clarity of intent
Completes all responsibilities as outlined on annual Performance Plan
Completes all special projects and other duties as assigned