The Policy Design Specialist role involves managing health plan clients and executing monthly project requests. Responsibilities include maintaining and implementing medical policies aligned with healthcare industry coding guidelines, performing data analysis for coding updates and customizations, and ensuring quality assurance for claim editing recommendations.
Key duties:
- Implement and update client policies in accordance with industry standards.
- Design client-requested policies translating expectations into Cotiviti guidelines.
- Manage multiple client projects and priorities.
- Provide top-tier customer service by addressing client needs and configuration issues.
- Meet production and quality targets, perform audits and corrections.
- Conduct quality checks using data analysis to troubleshoot and resolve errors.
- Participate in peer reviews and provide constructive feedback.
- Resolve policy configuration conflicts and participate in client presentations.
- Maintain up-to-date knowledge of internal applications and communicate effectively across teams.
Qualifications:
- Bachelor's degree preferred or equivalent experience.
- Preferred coding/HIM credentials (RHIA, CPC).
- 1+ year knowledge in medical terminology, anatomy, physiology.
- 2+ years experience in claim payment/adjudication or related healthcare payment policy.
- Proficient in Microsoft Office; SQL experience preferred.
- Strong analytical, communication, teamwork, and multitasking skills.
Job details:
- Remote (US only), with possible minimal travel and some after-hours work.
- Work requires prolonged computer use and a dedicated secure workspace.
Compensation is hourly ($23-$25/hour), with overtime eligibility as applicable.
Benefits include medical, dental, vision, disability, life insurance, 401(k), paid family leave, holidays, and PTO.
Application deadline is tentative and subject to change.
Bachelor's Degree preferred or equivalent work experience. Coding or HIM credentials preferred (RHIA, CPC, etc.). 1+ years understanding of medical terminology, anatomy and physiology. 2+ years experience in claim payment/adjudication, medical payment policy, hospital administration, or equivalent. Proficient with Microsoft Office Suite. Experience with SQL preferred. Ability to work independently and in teams, manage multiple tasks, strong analytical and communication skills.
Competitive benefits package including medical, dental, vision, disability, life insurance coverage, 401(k) savings plans, paid family leave, paid holidays, and Paid Time Off (PTO).
Location
N/A
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
Yes
Posted
1 month ago