Client Policy Manager I

Overview

The Client Policy Manager I manages client payment policies by ensuring client’s payment policy is accurate, up-to-date, and complete; executes client-specific requests with guidance from internal team and acts as the internal and external client team liaison.

Responsibilities

This position is client facing and requires a commitment to superior client service.

• Primarily responsible for the integrity of the client’s medical policy 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 industry updates. Review and identify changes needed to client policies in order to maintain up-to-date and accurate medical payment policies.
• Prepare payment policy documents for presentation to the client. Review all documents and coordinate reviews with Medical Directors and participate in client policy meetings.
• Conduct research and analysis for medical policy items with guidance from Cotiviti Client Medical Director and Content.
• Review client payment policies for accuracy, complete reviews on a timely basis, clearly understand and articulate medical policies, present the policies for consideration to Cotiviti Client Medical Director for review and acceptance by the client, provide direction on client understanding of medical policies.
• Add value to medical policy content, department, and client teams by participating and offering benefit of knowledge and experience proactively.
• Clearly understand, document and maintain client medical policy sensitivities and nuances in the Client Profile Workbook.
• Communicate effectively with various members of the client team (internal as well as external).
• Perform multi-faceted data and report analytics.
• Apply project management principles in initiating, creating, and managing projects.
• Review and analyze client inquiries for clarity of intent, apply decisions for affected policies, maintain information, and communicate effectively with the client.
• Completes all responsibilities as outlined on annual Performance Plan.
• Completes all special projects and other duties as assigned.

Qualifications

• Active professional license as a Registered Nurse (BSN preferred) or Bachelor’s Degree in Healthcare related field or relative experience.
• Professional coder certification (CPC, CPC-H, CPC-P or CCS-P).
• Minimum of 3 years clinical coding experience, preferable in a payer setting.
• Strong knowledge of healthcare claims payment policy and processing, specifically, CMS, Medicaid, ICD, CPT, HCPCS and other specialty society, etc.
• Experience in claims adjudication or utilization review working for a managed care or healthcare …