Client Policy Manager

About the role

This client-facing position requires a commitment to superior client service. The Client Policy Manager I ensures the client’s payment policy is accurate, up-to-date, and complete, executes client-specific requests with guidance from the internal team, and acts as the liaison between internal and external client teams.

Responsibilities

• Maintain 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.
• Drive the Periodic Update analysis and industry updates.
• Review and identify changes needed to client policies to maintain up-to-date and accurate medical payment policies.
• Prepare payment policy documents for presentation to the client.
• Review all documents and coordinate reviews with Medical Directors; participate in client policy meetings.
• Conduct research and analysis for medical policy items with guidance from Cotiviti Client Medical Director and Content.
• Review client payment policies for accuracy, complete reviews on a timely basis, and clearly articulate medical policies.
• Present policies for consideration to Cotiviti Client Medical Director for review and acceptance by the client; provide direction on client understanding of medical policies.
• Add value to medical policy content, department, and client teams by proactively participating and offering knowledge and experience.
• Document and maintain client medical policy sensitivities and nuances in the Client Profile Workbook.
• Communicate effectively with various members of the client team (internal and external).
• Perform multi-faceted data and report analytics.
• Apply project management principles in initiating, creating, and managing projects.
• Review and analyze client inquiries for clarity of intent, apply decisions for affected policies, maintain information, and communicate effectively with the client.
• Complete all responsibilities as outlined on the annual Performance Plan.
• Complete special projects and other duties as assigned.

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 of clinical coding experience, preferably in a payer setting.
• Strong knowledge of healthcare claims payment policy and processing, specifically CMS, Medicaid, ICD, CPT, HCPCS, and other specialty society guidelines.
• 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 the healthcare setting.
• Strong knowledge of CMS guidelines and experience with health plans, managed care, or healthcare insurance companies.
• Prior experience in developing medical payment policy edits.
• Proficiency in Microsoft Office suite.
• Demonstrated problem-solving skills and ability to handle confidential information professionally.
• Ability to work well both independently and collaboratively in a fast-paced and demanding environment.
• 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.

Cognitive/Mental Requirements

• Flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
• Ability to perform duties with or without reasonable accommodation.
• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of assigned work.

Physical Requirements and Working Conditions

• This is a remote role that can be located anywhere in the continental US.
• Travel requirement up to 20%.
• Must be able to lift up to 20 lbs without assistance.
• After-hours and/or weekend work may be required for major deliverables or deadlines.
• Must be able to sit and use a computer keyboard for extended periods.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must provide a dedicated, secure work area with high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions are expected.

Pay

Base compensation ranges from $78,000 to $106,000 per year. Specific offers are determined by various factors, including experience, education, skills, certifications, and other business needs.

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.