Job Category: Medical , Finance, Customer Service
Location: United States (Home-based)
To be discussed.
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 theinternal 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 ruleset, 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 client’s payment policies for accuracy.
- Completes reviews on a timely basis.
- Clearly understands and articulates medical policies.
- Presents the policies forreview and acceptance by the client.
- Provides direction on client understanding of medical policies.
- Adds value to Medical Policy andclient 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:
- Experience in claim payment adjudication or medical payment policy.
- Experience in CPT-4, ICD-9-CM and HCPCS coding.
- Proficient in Microsoft Office Excel, Word and PowerPoint.
- Working knowledge of Cotiviti systems.
- Demonstrates basic working knowledge of less than three of the following applications: CDM (working PUR, creating adhoc presentation, capturing decisions, create NPP presentation), eLL, RMI, RMR, Business Objects Reporting and SQUISH.
- Experience in customer service or client management with a strong focus on healthcare setting.
- Strong Knowledge of CMS guidelines.
- Health plans, Managed Care or Health Care insurance company experience.
- Prior experience in developing medical payment policy edits.
- Experience in claims adjudication or utilization review working for a managed care or healthcare insurance company.
- Effective problem solving skills.
- Professional with ability to properly handle confidential information.
- Ability to work well independently and in a team environment. Ability to handle multiple tasks, prioritize and meet deadlines.
- Excellent written and verbal communication skills.
- Must be able to sit and use a computer keyboard for extended periods of time.
- After hours and/or weekend work may be required where necessary for major deliverables/deadlines (not consistent).
- Travel requirement up to 25%.
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