Medical Policy Director

Role Overview

• 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

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