Cotiviti logo
Cotiviti

Enabling a high-quality and viable healthcare system

Medical Policy Director

DirectorDirectorFull TimeRemoteLeadTeam 5,001-10,000H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

35 days ago

Salary

$120K - $145K / year

Seniority

Lead

Bachelor Degree7.5 yrs expEnglish

Job Description

Medical Policy Director

Cotiviti

• Act as a knowledgebase expert regarding the Cotiviti Medical Policy library • Gain an understanding of each client’s unique lines of business, medical policy standards and system configuration strategy to inform optimization opportunities • Analyze client data and identify new medical policy opportunities for presentation including valuation and validation of editing • Examine and select specific claim examples to utilize in a presentation to the client to support the understanding of the new medical policy • Prepare various documents and presentation materials for use during internal payment policy committee meetings and/or client meetings • Review all documents and coordinate reviews with the CMD to evaluate and validate the editing and financial impact • Confidently perform client policy presentations to highlight the facts of each rule, the data that supports the policy recommendation, the impact to claims processing, and the associated value • Successfully advocate for the adoption of new medical policies by clients to optimize the value Cotiviti offers • Participate in client meetings as required as a medical policy subject matter expert • Coordinate with the internal client team to ensure that all requested follow-up items are delivered to the client • Inspire trust and credibility with clients • Communicate effectively across various organizational levels and members of the internal and external client teams • Assist in identifying opportunities for other Cotiviti product solutions • Complete all responsibilities as outlined in the annual performance review and/or goal setting • Complete all special projects and other duties as assigned

Job Requirements

  • Bachelor’s Degree in a relevant field or equivalent
  • Professional coder certification required (CPC, CPC-A, CCA, CCS, or CCS-P), RHIT or RHIA certification a plus
  • Minimum of 7-10 years of work experience, preferably in sales, customer service or client management
  • Minimum of 5 years of experience in claim payment adjudication, medical payment/policy editing applying Medicare, Medicaid, ICD, CPT, HCPCS and other specialty society guidelines preferred
  • Exceptional presentation, interpersonal, verbal and written communication skills
  • Superior organizational skills with the ability to work in a fast-faced environment, prioritize, and manage multiple competing deadlines with minimal direction
  • Strong problem-solving skills and an ability to think strategically
  • Ability to analyze complex data and synthesize it for general consumption
  • Excellent computer skills in Microsoft Word, Excel, PowerPoint, and Outlook are a must
  • Willingness/availability to travel 10-20% is required

Benefits

  • medical, dental, vision insurance
  • disability insurance
  • life insurance coverage
  • 401(k) savings plans
  • paid family leave
  • 9 paid holidays per year
  • 17-27 days of Paid Time Off (PTO) per year

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