Client Policy Manager 10/10/2017
Cotiviti USA, LLC
JOB DESCRIPTIONAPPLY Description
The Client Policy Manager I manages client payment policies by ensuring client s payment policy is accurate, up-to-date and complete. Ensuring execution of client specific requests and acting as the internal and external client team liaison.
* Reviews all documents and coordinates reviews with the Medical Directors
* Conducts research and analysis for medical policy items
* Primarily responsible for the integrity of the client's medical policy rule set, including awareness of all client-related Medical Policy Project Requests, monthly review of Max Units, review of Health Plan rules, etc.
* Primary driver of the Periodic Update Analysis and participates in monthly/quarterly client policy meetings:
* Reviews clients payment policies for accuracy
* Completes reviews on a timely basis
* Clearly understands and articulates medical policies
* Presents the policies for review and acceptance by the client
* Provides direction on client understanding of medical policies
* Adds value to Medical Policy and client teams
* Participates on Medical Policy and client teams
* Offers benefit of knowledge and experience proactively
* Communicates effectively with various members of the client team (internal as well as external)
* Responsible for translating industry references into Cotiviti policy
* Reviews and identifies changes needed to client policies in order to maintain up-to-date and accurate medical
payment policies. * Performs multi-faceted analytics in all data and report analysis
* Applies project management principles in initiating, creating and managing projects
* Reviews and analyzes client inquiries for clarity of intent, applying decisions for affected policies, maintaining information and communicating effectively with the client.
What we re looking for:
* Bachelor s Degree (or higher) preferred (or equivalent experience).
* Professional coder certification (CPC, CPC-H, CPC-P or CCS-P) or LPN or RN with medical coding knowledge
* Experience in claim payment adjudication or medical payment policy.
* Experience in CPT-4, ICD-10-CM and HCPCS coding.
* Experience in claims adjudication or utilization review working for a managed care or healthcare insurance company.
* Experience in customer service or client management with a strong focus on healthcare setting.
* Working knowledge of Cotiviti systems.
* Clearly understands and articulates medical policies.
* Strong Knowledge of CMS guidelines. Health plans, Managed Care or Health Care insurance company experience.
* Prior experience in developing medical payment policy edits.
* Demonstrates working knowledge of the following applications: CDM (working PUR, creating adhoc presentation, capturing decisions, create NPP presentation), eLL, RMI, RMR, Business Objects Reporting and RVA.
* Proficient in Microsoft Office Excel, Word and PowerPoint.
* Excellent written and verbal communication skills.
* Travel requirement up to 25%.
* We are an Equal Opportunity Employer.
* Please view Equal Employment Opportunity Posters provided by OFCCP here.
* Cotiviti is an Equal Opportunity Employer. The Company provides equal employment opportunities to all applicants for employment without regard to gender, sexual orientation or preference, gender identity or expression, race, color, religion, national origin, ethnicity, ancestry, age, marital status, pregnancy, childbirth or related medical conditions, mental or physical disability, veteran status or any other characteristic protected by federal, state or local law, ordinance or regulation..
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. We are also an equal opportunity employer of individuals with disabilities and protected veterans. Please view Equal Employment Opportunity Posters provided by OFCCP here.