- Creates and captures decisions when appropriate CDM Presentations (New Policy Presentations, Periodic Updates, and Prior Approvals)
- Creates and closes Project Requests as defined by CPM/CSM
- Conducts initial CCI deviations table review (post-implementation)
- Assist CPM in research and analysis to produce comparison reports for Outpatient Hospital, Professional, and DME Max Unit Tables to CPM as requested by the client team
- Reviews, analyzes, and responds to Research Request(s) by defined desired completion date or communicates when desired completion date needs to be adjusted due to complexity
- Supports Client Policy Manager through the various aspect of the Periodic Update, Prior Approval, and New Policy Processes
- Communicates effectively with various members of the Client Team(s)
- Performs multi-faceted analytics in data and report analysis
- Running of Release Validation Reports and completing the review of the data (twice per release cycle)
- Running Max Units Reports, completing the review of the data, and making recommendations for changes/updates
- Review of Pre & Post Release Testing Reports
- Generate, modify and format BO/Webi Reports for adhoc purposes and provides analysis.
- Ability to validate the Release Validation Report (RVR) report post-release.
- Manual JIRA creation and client response
- Client Inquiry Log entries and reporting
- Ability to research and examine client questions to draft an accurate response
- Actively participate in team meetings and other relevant meetings
- Other duties as assigned.
- Effective problem-solving skills
- Prior experience in developing medical payment policy edits
- Professional with the ability to properly handle confidential information
- Ability to work well independently and in a team environment.
- Ability to handle multiple tasks, prioritize and meet deadlines.
- Excellent written and verbal communication skills.
- Attention to detail and accuracy
- Organizational skills
- Works with a sense of urgency
- Ability to follow defined policies and procedures
- Strong analytical and problem-solving ability
- Strong interpersonal skills
- US Healthcare industry and claims analysis experience
- Desire and capacity to learn new concepts and software
- Ability to work within a matrix organization
- Exhibits behaviors consistent with Cotiviti Values
- Customer Driven
- Accountable
- Open
- Collaborative
- High School Diploma or GED required, Bachelor's degree preferred
- Prefer experience with Medical Coding and Terminology and/or clinical exposure, (CPC, CCS, or RHIA certification)
- Excellent analytical skills with the ability to troubleshoot problems and find root causes.
- Proficiency required in Business Objects (or similar business intelligence software), and relational databases.
- Advanced knowledge of Excel (pivot tables, complex formulas, VLOOKUPs, statistical functions).
- Ability to learn and quickly absorb new material.
- Ability to adapt to changing situations with ease.
- Team player with a strong desire to assist and share knowledge.
- Flexible schedule to work evenings and weekends, as needed.
- Must be able to sit and use a computer keyboard for extended periods of time
- Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
- This is an at-home-based position and you must have a work location within the continental US
- Interviewing & training will be done remotely.
- This position requires that you provide a high-speed internet connection and a work environment free from distractions
Date of posting: 3/14/2024
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