Client Policy Manager

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

📋 Description

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

• Execute specific requests from clients with support from the internal team, serving as the liaison for both internal and external client teams.

• Uphold the integrity of client medical policy sets, which includes managing Medical Policy project requests, conducting monthly Max Units reviews, and reviewing Health Plan rules.

• Lead analyses of Periodic Updates and industry changes.

• Assess and pinpoint necessary changes to keep medical payment policies accurate.

• Prepare payment policy documents for client presentations.

• Coordinate document evaluations with Medical Directors and take part in client policy meetings.

• Conduct research and analysis on medical policy items with guidance from the Cotiviti Client Medical Director and Content teams.

• Review, articulate, present, and explain client medical policies for review and acceptance.

• Document and preserve client medical policy sensitivities and details in the Client Profile Workbook.

• Communicate effectively with both internal and external client team members.

• Perform comprehensive data and report analytics.

• Initiate, create, and manage projects by applying project management principles.

• Review and analyze client inquiries, identify impacted policies, maintain relevant information, and communicate findings with clients.

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

⛳️ Requirements

• Valid professional license as a Registered Nurse (BSN preferred), or a Bachelor’s Degree in a healthcare-related field, or equivalent 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.

• In-depth knowledge of healthcare claims payment policy and processing, including CMS, Medicaid, ICD, CPT, HCPCS, and standards from specialty societies.

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

• Familiarity with claims payment and reimbursement methodologies.

• Experience in customer service or client management within a healthcare context.

• Capability to understand and articulate medical policies clearly.

• Strong understanding of CMS guidelines.

• Background in health plans, managed-care, or healthcare insurance companies.

• Prior experience in developing medical payment policy edits.

• Proficiency in Microsoft Office Suite.

• Proven problem-solving abilities.

• Capacity to handle confidential information appropriately.

• Ability to work both independently and collaboratively in a dynamic environment.

• Skills to analyze data and synthesize it for clients and internal stakeholders.

• Effective verbal, written, and interpersonal communication capabilities.

• Competence in managing timelines and multiple projects, prioritizing tasks, and meeting deadlines.

• Willingness to engage in an international organization's work processes, including participation in conference calls across global time zones.

• Ability to perform duties with or without reasonable accommodation.

• Willingness to travel up to 20%.

• Ability to lift up to 20 lbs without assistance.

• Availability to work after hours and/or on weekends when essential for major deliverables or deadlines.

• Capability to sit and use a computer keyboard for extended periods.

• Provision of a dedicated, secure work area.

• Access to high-speed internet connectivity and maintenance of an office setup.

• Must reside within the continental United States.

🏝️ Benefits

• Comprehensive medical, dental, vision, disability, and life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays annually.

• 17-27 days of Paid Time Off (PTO) each year, based on specific level and length of service.

• Option for remote work arrangements.

• Commitment to equal employment opportunity.