Client Policy Manager I

Responsibilities

• Manage client payment policies ensuring accuracy, completeness, and timeliness.
• Execute client-specific requests with guidance from internal team and external clients.
• Drive 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 client presentations.
• Coordinate reviews with Medical Directors and 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 and completeness, clearly articulate medical policies, and present them for client review.
• Add value to medical policy content, department, and client teams by 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, and communicate effectively with the client.

Qualifications

• Active professional license as a Registered Nurse (BSN preferred) 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, preferably in a payer setting.
• Strong knowledge of healthcare claims payment policy and processing, specifically CMS, Medicaid, ICD, CPT, HCPCS, and other specialty societies.
• 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.
• Clearly understands and articulates medical policies.
• Strong knowledge of CMS guidelines.
• Health plans, Managed Care, or Health Care insurance company experience.
• Prior experience in developing medical payment policy edits.
• Proficiency in Microsoft Office suite.
• Demonstrated problem-solving skills.
• Professional with ability to properly handle confidential information.
• Able to work well independently and collaboratively in a fast-paced and demanding environment.
• Able to analyze data and synthesize it for customer and internal consumption.
• Effective verbal and written communication, and interpersonal skills.
• Able to manage timelines and multiple projects with the ability to prioritize and meet deadlines.