Medical Policy Director

Responsibilities

• 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.
• 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.
• Aid in identifying opportunities for other Cotiviti product solutions.

Qualifications

• 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-paced 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.