Remote Client Policy Lead — Payments & Compliance

Cotiviti; Idaho; Remote; USD 78,000 - 106,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability insurance

Life insurance

401(k) savings

Paid family leave

9 paid holidays per year

Paid Time Off

Job summary

Cotiviti is seeking a Client Policy Manager I to oversee client payment policies, ensuring accuracy, currency, and alignment with healthcare guidelines. This remote role requires coordination with internal medical directors and clients, handling policy updates, and conducting policy-related analytics.

The role emphasizes data analysis, meticulous documentation, and effective communication within a fast-paced, global environment.

Qualifications

• Active RN license or healthcare-related bachelor’s degree.
• Professional coder certification (CPC, CPC-H, CPC-P or CCS-P).
• Minimum of 3 years clinical coding experience, preferably in a payer setting.
• Strong knowledge of healthcare claims payment policy and processing (CMS/Medicaid).
• Experience in claims adjudication or utilization review with managed care or health insurer.
• Familiarity with claims payment and reimbursement methodologies.
• Experience in customer service or client management in healthcare.
• Ability to articulate medical policies clearly.
• Knowledge of CMS guidelines and health plans.

Responsibilities

• Manage client payment policies for accuracy and currency.
• Coordinate with Medical Directors and clients for policy reviews.
• Conduct periodic updates and industry trend analyses.
• Prepare and present payment policy documents to clients.
• Research and analyze medical policy items with guidance from Cotiviti team.
• Communicate policy details to internal and external stakeholders.
• Maintain client medical policy sensitivities in the Client Profile Workbook.
• Perform data and report analytics related to policies.
• Apply project management to new and ongoing initiatives.
• Address client inquiries and translate into policy actions.

Skills

Healthcare analytics

Client management

Data analysis

Microsoft Office

Problem solving

Verbal and written communication

Project management

Time management

Education

Nursing license or healthcare degree

Coder certification (CPC/CPC-H/CPC-P/CCS-P)

Tools

CMS guidelines

Job description

Cotiviti is seeking a Client Policy Manager I to oversee client payment policies, ensuring accuracy, currency, and alignment with healthcare guidelines. This remote role requires coordination with internal medical directors and clients, handling policy updates, and conducting policy-related analytics.

The role emphasizes data analysis, meticulous documentation, and effective communication within a fast-paced, global environment.