[Hiring] Policy Design Specialist I @Cotiviti

Role Description

The Policy Design Specialist role is responsible for managing health plan clients and executing monthly project requests. Key responsibilities include:

• Implementing new policies and updating existing policies for clients to ensure alignment with industry standards and client expectations.
• Writing and designing client-requested policies from scratch, translating client expectations into Cotiviti guidelines.
• Executing project requests, designing work orders, and actively monitoring queues to ensure timely completion.
• Balancing multiple priorities and managing project deliverables for two or more healthcare clients.
• Providing high-level customer service by documenting and staying current on client sensitivities and configuration needs.
• Meeting daily and monthly production and quality targets while maintaining accuracy in all work.
• Performing regular quality checks to ensure accuracy for all client policies.
• Conducting Peer Review responsibilities by providing feedback to peers and proposing solutions to minimize error rates.
• Resolving testing issues and conflicts related to policy configuration updates.
• Analyzing pre and post-client claim data to ensure appropriate claim editing.
• Participating in client presentations by providing configuration expertise and managing post-presentation activities.
• Maintaining up-to-date knowledge of internal applications and participating in trainings and software release meetings.
• Communicating effectively and timely with upstream functional areas to resolve issues.

Qualifications

• 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, or hospital administration.
• Proficient with Microsoft Office Suite (Word, Excel, PowerPoint).
• 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.

Requirements

• This is a work at home position (US only).
• Long-term minimal travel may be required for this role.
• Flexibility and willingness to participate in international work processes, including conference calls across global time zones.
• After hours and/or weekend work may be required for major deliverables/deadlines.
• Ability to manage stress, such as high work volume and frequent change.

Benefits

• Base compensation ranges from $23.00 to $25.00 per hour.
• Nonexempt employees are eligible for overtime pay for hours worked over 40 in a week.
• Competitive benefits package including 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 level and length of service.