Policy Design Specialist – Level I

Role Overview

• 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
• Coordinates and manages 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

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

Tech Stack

• SQL

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