Client Policy Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee client payment policies to guarantee they are precise, current, and comprehensive.

• Implement client-specific requests under the guidance of the internal team and serve as the liaison between internal and external client teams.

• Uphold the integrity of the medical policy set for clients.

• Monitor client-related medical policy project requests and perform monthly reviews of Max Units and Health Plan regulations.

• Lead the analysis of Periodic Updates and industry changes.

• Evaluate and identify necessary modifications to client policies.

• Develop payment policy documents for client presentations.

• Organize document reviews with Medical Directors and engage in client policy meetings.

• Conduct medical policy research and analysis with input from Cotiviti Client Medical Director and Content.

• Scrutinize client payment policies for accuracy and timeliness.

• Clearly comprehend and communicate medical policies, presenting them to the Cotiviti Client Medical Director for review and client approval.

• Provide guidance on client comprehension of medical policies.

• Record and maintain client medical policy sensitivities and details in the Client Profile Workbook.

• Liaise with internal and external client team members.

• Execute multifaceted data and report analytics.

• Utilize project management principles to initiate, develop, and oversee projects.

• Assess client inquiries, identify impacted policies, maintain information, and convey decisions to clients.

• Fulfill annual Performance Plan responsibilities, special projects, and other assigned tasks.

⛳️ Requirements

• Current professional license as a Registered Nurse (BSN preferred) or a Bachelor’s Degree in a Healthcare-related field or relevant experience.

• Professional coder certification (CPC, CPC-H, CPC-P or CCS-P).

• At least 3 years of clinical coding experience, ideally in a payer environment.

• Extensive knowledge of healthcare claims payment policy and processing, including CMS, Medicaid, ICD, CPT, HCPCS, and specialty society standards.

• Experience in claims adjudication or utilization review within a managed care or healthcare insurance organization.

• Understanding of claims payment and reimbursement methodologies.

• Background in customer service or client management in a healthcare context.

• Strong understanding of CMS guidelines.

• Familiarity with health plans, managed care, or healthcare insurance companies.

• Previous experience in developing medical payment policy edits.

• Proficient in Microsoft Office suite.

• Proven problem-solving abilities.

• Capacity to handle confidential information appropriately.

• Ability to work independently and collaboratively in a fast-paced, demanding environment.

• Skill in analyzing data and synthesizing it for both customer and internal purposes.

• Effective verbal and written communication as well as interpersonal skills.

• Capability to manage timelines and multiple projects, prioritize tasks, and meet deadlines.

• Flexibility and willingness to engage in an international organization's work processes, including accommodating global time zones for conference calls.

• Must be capable of performing duties with or without reasonable accommodation.

• Able to lift up to 20 lbs without assistance.

• Must be able to sit and use a computer keyboard for extended periods.

• Must have a dedicated, secure work area.

• Must ensure high-speed internet access/connectivity and maintain office setup.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Disability insurance.

• Life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays each year.

• 17–27 days of Paid Time Off (PTO) annually, based on level and length of service.

• Remote work opportunities.

• Up to 20% travel requirement.

• Employee-provided dedicated, secure work area and high-speed internet access/connectivity, along with office setup and maintenance.