Policy Design Specialist I

Job description

Overview The Policy Design Specialist role is responsible for managing health plan clients and executing monthly project requests. Perform policy configuration maintenance of current medical policies along with implementing new health plan medical policies per client request. Adhere to and remain in alignment with the most up to date healthcare industry medical coding guidelines. Perform data analysis to determine how to accurately apply coding updates and client requested customizations. Execute quality assurance checks to ensure appropriate claim editing recommendations are applied based on client request. Responsibilities: - Implement new policies and update existing policies for clients to ensure the policy is editing in accordance with the industry and per the client’s expectation. - Write and design client requested policies from scratch, translating client expectations into Cotiviti guidelines to ensure appropriate configuration. - Execute projects requests, design work orders, and actively monitor queues to ensure all requests are completed by the desired completion date. - Balance multiple priorities and manage projects deliverables for two or more healthcare clients. Proa...