The Client Policy Manager provides expert consultation on coding & clinical policy guidelines . This role works directly with our health plan clients and manages our clients payment policies and ensures they are accurate, up-to-date, and complete. This role is responsible for interpreting and assessing payment policy for clients and provides consultation and policy advice. This role works with a team of others: Medical Director, Client Managers, and Financial professional to deliver and implement clinical & coding guideline changes to their assigned clients.

Policy Management

Works with Medical Policy / Client team, aiding them in the evaluation and validation of editing, validation of savings as well as making selection for new policy opportunities including weighting of new rules.
• Selects claims examples to utilize in presentation to the client & presents payment policy to clients for selection.
• Clearly understands and articulates medical policies. Presents policy changes for review and acceptance by the client. Provides direction on client understanding of medical policies.
• Reviews all documents and coordinates reviews with the Medical Directors.
• Conducts research and analysis for medical policy items.
• Primarily responsible for the integrity of the client's medical policy set, including awareness of client-related Medical Policy Project Request, monthly review of Max Units, review of Health Plan rules, etc.
• Primary driver of the Periodic Update Analysis and leads monthly / quarterly client policy meetings.
• Reviews client's payment policies for accuracy and completes on a timely basis.
• Builds Cotiviti value and credibility with clients by inspiring trust - delivers on commitments.
• Communicates effectively with various members of the client team (internal as well as external).
• Responsible for translating industry references into Cotiviti, Cotiviti policy.
• Performs multi-faceted analytics in all data and report analysis.
• Applies project management principles in initiating, creating and managing projects.
• Reviews and analyzes client inquiries for clarity of intent, applying decisions for affected policies, maintaining information and communicating effectively with the client.
• Provides expert consultation during the planning through operations phases, regarding coding regularity requirements and clinical policy guidelines.
• Function as a key member of the implementation team to collect, collate and articulate the client's clinical and payment policies.
• Acts as the key liaison for the clinical information between internal partners and external customers during operations phases.
• Responds to client inquiries in a timely manner in compliance with policy and procedures.
• Works collaboratively with the Account Manager and Sales Executive to develop excellent client relationships.
• Provides clients with high quality and customized analysis of quarterly and ad hoc reports and recommends new reports that would be useful to their clients.
• Assists the Clinical Content Team with research of new trends and applications for new rules.
• Provides support to the sales team when presenting clinical information to prospective clients as needed.
• Provides client support during user acceptance testing.
• Completes all responsibilities as outlined on annual Performance Plan.
• Completes all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

• Active professional license as a Registered Nurse (BSN preferred) or Bachelor's Degree in Healthcare related field or equivalent relevant experience.
• CPC or equivalent certification required.
• Minimum of 3 years clinical coding experience, preferable in a payer setting.
• Possesses knowledge of healthcare claims payment policy and processing, specifically, CMS, Medicaid, ICD, CPT, HCPCS and other specialty society, etc.
• In depth knowledge of claims, claims adjudication, medical policy logic and recommendations.
• Proficiency in Microsoft Office suite...advanced skills in Excel preferred
• Familiarity with claims payment and reimbursement methodologies.
• Ability to analyze complex data and synthesize it for customer and internal consumption.
• Ability to work well both independently and collaboratively, in a fast-paced and demanding environment.
• Effective at managing timelines and multiple projects.
• Effective presentation, verbal and written communication, and interpersonal skills.
• Ability to travel approximately up to 10% of the time (likely less).

Job Demands

• This is a remote role and can be located anywhere in the continental US.
• Minimal travel requirements.
• After hours and/or weekend work may be required where necessary for major deliverables /deadlines.
• Must be able to sit and use a computer keyboard for extended periods of time.
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.

Base compensation ranges from $72,000 to $100,000. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 5/3/2024

Applications are assessed on a rolling basis. We anticipate that the application window will close on 7/3/2024, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

#LI-JB1

#LI-Remote

#senior