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Policy Design Specialist

Cotiviti Atlanta, GA

  • Expired: December 09, 2020. Applications are no longer accepted.

The Policy Design Specialist role is responsible for developing and processing Rule Maintenance Requests (RMRs) and configuring rules associated with them for each monthly release by the configuration cutoff date reflected on the Release Schedule. This role is the subject matter expert for the department.

Responsibilities:

  • Translate client policy request intentions into Cotiviti configuration instructions to ensure the policy is editing in accordance with the policy descriptions and per the client’s expectation.
  • Build and process Rule Maintenance Requests (RMR) within the Lotus Notes application to design new policy rules and rule versions within the Rules Maintenance Interface (RMI) application. Performs self-accuracy checks during this process by running QA on the individual rule(s) for each configured RMR.
  • Processes assigned Project Requests timely ensuring each request is completed by the desired completion date. Actively monitor assigned queues to ensure all requests (RMR, PR, RR etc.) are completed for the appropriate Release Month by the deadlines reflected in the production release schedule.
  • Configures rules in accordance with rule configuration guidelines defined in, training documents, departmental job aids, Process Guidelines, and/or the Document Management System (DMS).
  • Analyze the weekly Rule QA report and troubleshoot results, determining root cause(s) and resolving prior to the system lockdown for that monthly release cycle. 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.
  • Communicates effectively and timely with upstream functional areas to resolve issues.
  • Meets 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 QA’d per policy and corrections are made if needed.
  • Maintains high level knowledge of CDM functionality. Complete analysis for Industry Updates for Custom Policies. Assist in the completion of UAT of system enhancements by testing new functionality and reports.
  • Assists in the modification of process guidelines or other materials associated with new functionality and/or reports.
  • Implement Health Plan Policy Temp Rules
  • Participates in client presentations for Periodic Updates and New Policy information by providing RMI configuration expertise and documenting all client decisions.
  • Responsible for capturing client presentation decisions in CDM. Coordinates and manages post-client presentation activities.
  • Backs up the Supervisor for duties such as attending meetings, delegating work, resolving client issues.
  • Client facing - handling client facing issues either via phone or in person. Other duties as assigned

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 

Job Demands:

  • For the safety of our employees and those considering employment with Cotiviti, we are currently conducting all interviews virtually. In addition, the majority of the Cotiviti team is currently working remotely, and we are onboarding new hires remotely as well. As we monitor the pandemic, these arrangements may change and we will update accordingly....long term this position will work in our Atlanta office with limited remote work available, therefore, all applicants must be in the Atlanta area. 
  • This is currently work at home position.  Access to high speed internet is required (all other equipment will be provided). 
  • Not currently, but long term minimal travel may be required for this role.
  • Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
  • After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent)
  • Must have ability to positively handle/manage stress, such as high work volume and frequent change.

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Cotiviti

Address

Atlanta, GA
USA

Industry

Business

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