Enabling a high-quality and viable healthcare system
Policy Design Specialist I
Location
United States
Posted
2 days ago
Salary
$23 - $25 / hour
Seniority
Junior
Job Description
Policy Design Specialist I
Cotiviti
• Implement new policies and update existing policies for clients to ensure the policy is editing in accordance with the industry and per the client’s expectation • Write and design client requested policies from scratch, translating client expectations into Cotiviti guidelines to ensure appropriate configuration • Execute projects requests, design work orders, and actively monitor queues to ensure all requests are completed by the desired completion date • Balance multiple priorities and manage projects deliverables for two or more healthcare clients • Proactively assist on other client accounts where needed • Provide the highest level of customer service by documenting and staying current regarding all client sensitivities and configuration needs • Investigate situations where configuration updates conflict with client customizations or needs • Meet daily and monthly production and quality targets; maintaining an exemplary level of accuracy in all work; ensuring that the capture and completion of assigned projects are audited and that corrections are made where needed • Perform regular quality checks to ensure accuracy for all a client’s policy set by analyzing quality reports and troubleshoot results, determining root cause(s) and promptly resolving • Perform Peer Review responsibilities by providing feedback to peers assisting in achieving department quality goals • Receive peer feedback, identifying any trends and proposing concise solutions to minimize error rate • Resolve testing issues and conflicts related to policy configuration updates and policy overlaps • Analyze pre and post client claim data to ensure appropriate claim editing • Participate in client presentations by providing configuration expertise and capturing client decisions • Coordinate and manage post-client presentation activities • Maintain detailed and up to date knowledge of internal applications, actively participating in all trainings and software release meetings • Communicate effectively and timely with upstream functional areas to resolve issues
Job Requirements
- Bachelor's Degree preferred or equivalent work experience
- Coding or HIM credential preferred (RHIA, CPC, etc.)
- 1 or more years of experience / understanding of: medical terminology, anatomy and physiology
- Health plan payment policy experience or internal company payment policy experience
- 2 or more years of experience in claim payment/adjudication, medical payment policy, experience in hospital administration, or multispecialty experience and exposure to professional and facility claims (or equivalent Cotiviti experience)
- Proficient with Microsoft Office Suite (Word, Excel, Power Point)
- Experience with SQL preferred
- Ability to work well in a team environment or independently and perform well under pressure
- Strong analytical and problem-solving skills
- Excellent verbal and written communication skills.
Benefits
- medical, dental, vision, disability, and 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, depending on specific level and length of service with Cotiviti
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