Medical Policy Release Manager

Overview

The Medical Policy Release Manager is responsible for managing the medical policies releases, release schedule, and IT system related updates. This role oversees QA, validation, and release of medical policy content prior to production deployment. This person collaborates with the cross-functional teams creating and maintaining new content, software changes which are consistent and correctly reflected across all policy systems. This role will ensure that new policies or system changes are properly validated, documented, compliant with regulations, and released to production with minimal disruption.

Responsibilities

• Develop and maintain release calendars for medical policy updates or software patches, coordinate dependencies across multiple teams.
• Ensure all policy changes or technical releases comply with CMS, federal, state, and regulatory requirements (e.g., Medicare, Medicaid, AMA).
• Act as the liaison between Clinical Policy teams, IT, and Business operations to communicate release status, risks, and timelines.
• Lead go/no-go decisions, validate testing (UAT), and establish rollback procedures to handle potential deployment failures.
• Coordinate tickets and communicate data files status reflected in the Release Notes.
• Apply coding and industry expertise in clinical coding edits and industry references.
• Work with the client teams to provide support on PURs and other eLL inquiries.
• Maintain current knowledge of industry and Cotiviti content, applications, procedures and policies.
• Work well independently and collaboratively with the global team in a demanding environment.
• Participate in eLL applications upgrades or functionality changes.
• Manage risks and resolve issues that affect release scope, schedule, and quality.
• Escalate issues requiring executive attention promptly supported by an objective assessment.
• Leverage data for making sound data-driven decision making.
• Complete all responsibilities as outlined in the annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Must be able to perform all duties with or without reasonable accommodation.
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.

Qualifications

• Degree and Professional certification (AHIMA or AAPC) preferred.
• 6 years of coding experience in healthcare policy, billing & coding software, regulatory analysis, or IT release management.
• Familiarity with ITIL frameworks, Change Management tools (e.g., Jira, ServiceNow).
• Oversee release quality, schedule adherence and compliance with Cotiviti standards.
• Plan, schedule and coordinate releases across development, QA, and production environments.
• Ensure risk assessment, prioritization, approval, and change documentation.
• Manage release calendars, dependencies, and conflicts to minimize business disruption.
• Act as a key liaison across Engineering, QA, Operations and act as a gatekeeper for policy accuracy.
• Ability to interpret rule descriptions, scripts, and temporary rules.
• Experience validating policy and code changes in content management systems.
• Strong analytical and comparison skills for multi-tab validation.
• Work closely with eLL Editors on standardized timeframes, thresholds, and definitions.
• Validate changes across Medical Policy, History, and Current Changes to ensure accuracy and consistency.
• Experience in internet-based research as it relates to codes (CPT, HCPCS, ICD, or NDC).
• Familiarity with claims payment and reimbursement methodologies with ability to analyze data.
• Effective at managing timelines and multiple projects with high accuracy and attention to detail.
• Strong analytical, critical thinking, and problem-solving skills.
• Proficiency in Microsoft Office suite. Preferred knowledge of Excel, Pivot table, functions.
• Excellent interpersonal, verbal and written communication skills.
• This is a work at home position. Access to high-speed internet is required (other tools will be provided).
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
• After hours and/or weekend work required where necessary for major deadlines (not consistent).
• Behaves in a way that consistently demonstrates commitment to Cotiviti values.
• Demonstrates an understanding of Cotiviti policies, procedures, and external regulatory requirements regarding information security and compliance.
• Assures confidentiality and security of all data.

Cognitive/Mental Requirements

• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Making timely decisions in the context of a workflow.
• Maintaining focus.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• Remembering and adhering to processes and protocols.
• Applying established protocols in a timely manner.

Working Conditions and Physical Requirements

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Communicating with others to exchange information.
• Repeating motions that may include the wrists, hands and/or fingers.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Pay

Base compensation ranges from $105,000 to $125,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Benefits

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.