Client Policy Manager I
Remote, United States
Overview
The Client Policy Manager provides expert consultation on coding & clinical policy guidelines . This role works directly with our health plan clients and manages our clients payment policies and ensures they are accurate, up-to-date, and complete. This role is responsible for interpreting and assessing payment policy for clients and provides consultation and policy advice. This role works with a team of others: Medical Director, Client Managers, and Financial professional to deliver and implement clinical & coding guideline changes to their assigned clients.
Responsibilities
Policy Management:
- Works with Medical Policy / Client team, aiding them in the evaluation and validation of editing, validation of savings as well as making selection for new policy opportunities including weighting of new rules.
- Selects claims examples to utilize in presentation to the client & presents payment policy to clients for selection.
- Clearly understands and articulates medical policies. Presents policy changes for review and acceptance by the client. Provides direction on client understanding of medical policies.
- 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 set, including awareness of client-related Medical Policy Project Request, monthly review of Max Units, review of Health Plan rules, etc.
- Primary driver of the Periodic Update Analysis and leads monthly / quarterly client policy meetings.
- Reviews client’s payment policies for accuracy and completes on a timely basis.
- Builds Cotiviti value and credibility with clients by inspiring trust - delivers on commitments.
- Communicates effectively with various members of the client team (internal as well as external).
- Responsible for translating industry references into Cotiviti, Cotiviti policy.
- 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.
- Provides expert consultation during the planning through operations phases, regarding coding regularity requirements and clinical policy guidelines.
- Function as a key member of the implementation team to collect, collate and articulate the client’s clinical and payment policies.
- Acts as the key liaison for the clinical information between internal partners and external customers during operations phases.
- Responds to client inquiries in a timely manner …
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Must be able to perform duties with or without reasonable accommodation Must be able to provide a dedicated, secure work area Must be able to provide high-speed internet access
Benefits/Perks9 paid holidays per year Competitive benefits package Dental Disability Flexible schedule Life Insurance Life insurance coverage Medical Medical, dental, vision, disability, and life insurance coverage Paid Family Leave Paid holidays Paid Time Off Professional development Remote work Vision
Tasks- Client support
- Compliance
- Conduct research and analysis
- Other duties as assigned
- Policy Management
- Project management
- Research
- Research and Analysis
- Special projects
Access Analytics Client Consultation Client Support Clinical coding Coding Communication Compliance Computer Consultation CPT Data analysis Excel Exchange HCPCS Healthcare ICD Interpersonal IT Medicaid Medical Policy Microsoft Office Microsoft Office Suite Operations Payment Policy Management Presentation Project Management Reimbursement Research Sales User Acceptance Testing
Experience3 years
EducationBachelor's degree BSN Business Equivalent Equivalent relevant experience Health Healthcare related field Management Medical Operations Related Field Sales Senior
Certifications TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9