Client Policy Manager I Job Locations

US-Remote ID

2024-12637

Category Client Services  

Position Type Full-Time Overview

The Client Policy Manager provides expert consultation on coding and 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 and 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 and 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 in compliance with policy and procedures. * Works collaboratively with the Account Manager and Sales Executive to develop excellent client relationships. * Provides clients with high quality and customized analysis of quarterly and ad hoc reports and recommends new reports that would be useful to their clients. * Assists the Clinical Content Team with research of new trends and applications for new rules. * Provides support to the sales team when presenting clinical information to prospective clients as needed. * Provides client support during user acceptance testing. * Completes all responsibilities as outlined on annual Performance Plan. * Completes all special projects and other duties as assigned. * Must be able to perform duties with or without reasonable accommodation.

Qualifications

• Active professiona l license as a Registered Nurse (BSN... For full info follow application link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities