Client Policy Manager

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

📋 Description

• Oversee client payment policies to guarantee accuracy, currency, and completeness.

• Fulfill client-specific requests with support from internal teams and act as a liaison for both internal and external client teams.

• Ensure the integrity of client medical policy sets is maintained.

• Monitor project requests related to client Medical Policy.

• Perform monthly assessments of Max Units and Health Plan regulations.

• Lead analysis of Periodic Updates and industry developments.

• Recognize and implement necessary adjustments to maintain the accuracy and currency of client policies.

• Create payment policy documents for client presentations.

• Review documents, coordinate evaluations with Medical Directors, and engage in client policy discussions.

• Investigate and analyze medical policy items with guidance from the Cotiviti Client Medical Director and Content team.

• Review and explain medical policies, presenting them for review and client approval.

• Record and preserve client medical policy sensitivities and nuances in the Client Profile Workbook.

• Communicate effectively with internal and external client team members.

• Conduct complex data and report analytics.

• Employ project management principles to initiate, develop, and manage projects.

• Review and evaluate client inquiries, apply decisions to relevant policies, maintain information, and communicate results.

• Execute Performance Plan responsibilities, special projects, and any other assigned tasks.

⛳️ Requirements

• Active professional license as a Registered Nurse (BSN preferred) or 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, preferably in a payer environment.

• In-depth understanding of healthcare claims payment policies and processes, including CMS, Medicaid, ICD, CPT, HCPCS, and specialty society standards.

• Experience in claims adjudication or utilization review for a managed care or healthcare insurance company.

• Familiarity with claims payment and reimbursement strategies.

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

• Strong grasp of CMS guidelines, health plans, and operations within managed care or healthcare insurance companies.

• Previous experience in developing medical payment policy edits.

• Proficiency in the Microsoft Office suite.

• Proven problem-solving abilities.

• Capacity to handle confidential information appropriately.

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

• Competence in analyzing data and synthesizing it for both customer and internal use.

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

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

• Flexibility and willingness to engage in an international organization’s work processes, including participating in conference calls across different global time zones.

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

• Must be 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 workspace.

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

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Disability insurance.

• Life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays annually.

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

• Remote work options.

• Flexible scheduling to accommodate global time zones.

• Up to 20% travel required.

• Comprehensive employer-provided benefits package.