Client Policy Manager
总结：客户政策经理我通过确保客户的支付政策准确，最新和完整来管理客户支付政策；执行客户特定请求，受内部团队指导，并担任内部和外部客户团队联系人。责任本职位是客户面临的，需要致力于优质的客户服务。· 主要负责客户医疗政策集中的完整性，包括对所有与客户相关的医疗政策项目要求的认识，每月审查 Max 单位，评估健康计划规则等。·定期更新分析和行业更新的主要驱动因素。审查和确定客户政策所需的变化，以保持最新和准确的医疗支付政策。· 为客户提供支付政策文件做好准备。与医务主管进行审核并协调评估，并在客户政策会议上参与。· 在科蒂维蒂客户医疗主任和内容指导下对医疗政策项目进行研究和分析。· 审查客户支付政策以确定性，及时完成评估，清楚理解和阐明医疗政策，向 Cotiviti 客户医务总监提出考虑的政策，以便客户审查并接受这些政策，为客户提供对医疗政策的了解指导。·通过积极参与和提供知识和经验的利益来增加医疗政策内容，部门和客户团队的价值。· 在客户个人资料工作簿中清晰了解，记录和维护客户医疗政策敏感性和细微差异。· 与客户团伙 （内部和外部）的不同成员有效沟通。· 执行多方面的数据和报告分析。· 在启动，创建和管理项目时应用项目管理原则。· 对客户的查询进行清晰度的审查和分析，对影响政策的决定进行应用，保持信息并与客户有效沟通。· 按照年度绩效计划规划完成所有职责。· 根据所分配的所有特殊项目的和其他任务。本工作描述旨在描述正在进行的工作的一般性质和水平，不应被解释为要求责任，义务和技能的详尽列表。工作描述不构成雇佣协议，并且是：
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Overview
The Client Policy Manager I manages client payment policies by ensuring client’s payment policy is accurate, up-to-date, and complete; executes client-specific requests with guidance from internal team and acts as the internal and external client team liaison.
Responsibilities
This position is client facing and requires a commitment to superior client service.
- Primarily responsible for the integrity of the client’s medical policy set, including awareness of all client-related Medical Policy project requests, monthly review of Max Units, review of Health Plan rules, etc.
- Primary driver of the Periodic Update analysis and industry updates. Review and identify changes needed to client policies in order to maintain up-to-date and accurate medical payment policies.
- Prepare payment policy documents for presentation to the client. Review all documents and coordinate reviews with Medical Directors and participate in client policy meetings.
- Conduct research and analysis for medical policy items with guidance from Cotiviti Client Medical Director and Content.
- Review client payment policies for accuracy, complete reviews on a timely basis, clearly understand and articulate medical policies, present the policies for consideration to Cotiviti Client Medical Director for review and acceptance by the client, provide direction on client understanding of medical policies.
- Add value to medical policy content, department, and client teams by participating and offering benefit of knowledge and experience proactively.
- Clearly understand, document and maintain client medical policy sensitivities and nuances in the Client Profile Workbook.
- Communicate effectively with various members of the client team (internal as well as external).
- Perform multi-faceted data and report analytics.
- Apply project management principles in initiating, creating, and managing projects.
- Review and analyze client inquiries for clarity of intent, apply decisions for affected policies, maintain information, and communicate effectively with the client.
- Completes all responsibilities as outlined on annual Performance Plan.
- Completes all special projects and other duties as assigned.
This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.
Qualifications
- Active professional license as a Registered Nurse (BSN preferred) or Bachelor’s Degree in Healthcare related field or relative experience.
- Professional coder certification (CPC, CPC-H, CPC-P or CCS-P).
- Minimum of 3 years clinical coding experience, preferable in a payer setting.
- Strong knowledge of healthcare claims payment policy and processing, specifically, CMS, Medicaid, ICD, CPT, HCPCS and other specialty society, etc.
- Experience in claims adjudication or utilization review working for a managed care or healthcare insurance company.
- Familiarity with claims payment and reimbursement methodologies.
- Experience in customer service or client management with a strong focus on healthcare setting.
- Clearly understands and articulates medical policies.
- Strong Knowledge of CMS guidelines. Health plans, Managed Care or Health Care insurance company experience.
- Prior experience in developing medical payment policy edits.
- Proficiency in Microsoft Office suite.
- Demonstrated problem-solving skills.
- Professional with ability to properly handle confidential information.
- Ability to work well both independently and collaboratively, in a fast-paced and demanding environment.
- Ability to analyze data and synthesize it for customer and internal consumption.
- Effective verbal and written communication, and interpersonal skills.
- Effective at managing timelines and multiple projects with the ability to prioritize and meet deadlines.
Cognitive/Mental Requirements:
- Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
- Must be able to perform duties with or without reasonable accommodation.
- Communicating with others to exchange information.
- Assessing the accuracy, neatness, and thoroughness of the work assigned.
Physical Requirements and Working Conditions:
- This remote role can be located anywhere in the continental US.
- Travel requirement up to 20%.
- Must be able to lift up to 20 lbs without assistance.
- After-hours and/or weekend work may be required where necessary for major deliverables /deadlines.
- Must be able to sit and use a computer keyboard for extended periods.
- Remaining in a stationary position, often standing or sitting for prolonged periods.
- Repeating motions that may include the wrists, hands, and/or fingers.
- Must be able to provide a dedicated, secure work area.
- Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
- No adverse environmental conditions are expected.
Base compensation ranges from $78,000 to $106,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
Date of posting: 8/18/2026
Applications are assessed on a rolling basis. We anticipate that the application window will close on 10/18/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
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Originally posted on Himalayas