Medical Policy Director

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

📋 Description

• Serve as a subject matter expert on the Cotiviti Medical Policy library.

• Acquire knowledge of each client's distinct lines of business, medical policy standards, and system configuration strategies to identify optimization prospects.

• Analyze client data to uncover new medical policy opportunities for presentation, including the assessment and validation of editing.

• Review and select specific claim examples for client presentations to enhance understanding of the new medical policy.

• Prepare various documents and presentation materials for use in internal payment policy committee meetings and/or client meetings.

• Review all documents and coordinate evaluations with the CMD to assess and validate the editing and its financial implications.

• Confidently conduct client policy presentations to emphasize the details of each rule, the supporting data for policy recommendations, the impact on claims processing, and the associated value.

• Successfully champion the adoption of new medical policies by clients to maximize the value Cotiviti delivers.

• Participate in client meetings as needed as a medical policy expert.

• Collaborate with the internal client team to ensure all requested follow-up items are provided to the client.

• Foster trust and credibility with clients.

• Communicate effectively across various organizational levels and with members of both internal and external client teams.

• Assist in identifying opportunities for additional Cotiviti product solutions.

• Fulfill all responsibilities as detailed in the annual performance review and/or goal-setting.

• Complete all special projects and other assigned duties.

⛳️ Requirements

• Bachelor’s Degree in a relevant field or equivalent experience.

• Professional coder certification required (CPC, CPC-A, CCA, CCS, or CCS-P); RHIT or RHIA certification is a plus.

• At least 7-10 years of professional experience, ideally in sales, customer service, or client management.

• A minimum of 5 years of experience in claim payment adjudication, medical payment/policy editing with Medicare, Medicaid, ICD, CPT, HCPCS, and other specialty society guidelines preferred.

• Experience in health plans, managed care, or health insurance is preferred.

• Outstanding presentation, interpersonal, verbal, and written communication skills.

• Excellent organizational abilities with a capacity to thrive in a fast-paced environment, prioritize tasks, and manage multiple competing deadlines with minimal supervision.

• Strong problem-solving skills and a strategic mindset.

• Capability to analyze complex data and distill it for general understanding.

• Proven strategic and analytical thinking abilities, with talent in effectively communicating conclusions and recommendations to diverse audiences.

• Proficient computer skills in Microsoft Word, Excel, PowerPoint, and Outlook are essential.

• Willingness and availability to travel 10-20% is required.

🏝️ Benefits

• Medical, dental, vision, disability, and life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays per year.

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