Policy Design Specialist – Level I
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Policy Design Specialist managing health plan clients and executing monthly project requests at Cotiviti. Engaging with policy configuration and ensuring compliance with client expectations.
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
- Proactively assist on other client accounts where needed
- Provide the highest level of customer service by documenting and staying current regarding all client sensitivities and configuration needs
- Investigate situations where configuration updates conflict with client customizations or needs
- Meet 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 audited and that corrections are made where needed
- Perform regular quality checks to ensure accuracy for all a client’s policy set by analyzing quality reports and troubleshoot results, determining root cause(s) and promptly resolving
- 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
- Resolve testing issues and conflicts related to policy configuration updates and policy overlaps
- Analyze pre and post client claim data to ensure appropriate claim editing
- Participate in client presentations by providing configuration expertise and capturing client decisions
- Coordinates and manages post-client presentation activities
- Maintain detailed and up to date knowledge of internal applications, actively participating in all trainings and software release meetings
- Communicate effectively and timely with upstream functional areas to resolve issues
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
- 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
Benefits:
- 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 specific level and length of service with Cotiviti
Similar Jobs
Ehrenamtliche/r Grafikdesigner:in, Webdesigner:in
Graphic and web designer for Live Peace 2026, an international peace project. Contributing to visual communication and digital representation with creative freedom in a flexible remote role.
Site Manager – Design Build, EaaS, Construction
Site Manager overseeing commercial/industrial construction projects ensuring compliance and quality at Optimum Energy.
Learning Experience Designer I
Designer de experiências de aprendizagem at Inicie, focusing on interactive and humanized learning experiences for educational institutions. Requires strong background in instructional design and education.
Experiential Design Intern – 6 Months, Full Time
Experiential Design Intern supporting design team to develop immersive concepts and production of visual assets. Gain hands-on experience in collaborative and dynamic design environment.
Process Design Assistant
Process Design Assistant responsible for optimizing property management processes. Delivering customized solutions for multiple companies using ProfitCoach.
Senior Designer
Senior Designer crafting high-quality e-commerce brands and user experiences at a leading Shopify agency. Collaborating with clients and teams to deliver innovative solutions.
Product UI, Visual & Interaction Designer – Master-Level Internship
Seeking a Product UI/Visual & Interaction Designer Intern to enhance AI-powered products. Role involves UI design, motion interactions, and collaborating on design systems.
Senior Plumbing Designer, Revit
Senior Revit Plumbing Designer executing plumbing design via Revit for industrial systems. Collaborating with clients and applying knowledge of plumbing systems and codes.
Presentation Designer – Temporary
PowerPoint Presentation Designer creating engaging presentation slide decks for GMR Marketing. Supporting light video editing and maintaining cohesive brand presence across digital content.
Senior Silicon Photonics Chip Designer
Senior Silicon Photonics Chip Designer at Ciena shaping performance and manufacturability of optical transmitters and receivers. Collaborating in cross-functional teams to drive product innovation and improvements.
Graphic Designer – Social Ad Creatives, Freelance or Permanent
Graphic Designer creating effective Image Ad Creatives for paid social media ads. Working remotely to design and test ads primarily for Meta and TikTok, with a flexible freelance or employment option.
Design Intern
Design (Visual) Intern creating visual communication materials for Good Business Lab's social impact initiatives. Collaborating with designers and researchers in a remote environment.
Design & Web Assistant, m/f/d
Design & Web Assistant working on website maintenance, SEO, and creative projects for a sustainable toilet company. Engaging in tasks from design to technical support.
Graphic Design Internship
Internship in graphic design at a sustainable corporate merchandise startup. Collaborating on real projects with a young, motivated team in Munich.
Production/Studio Designer – Advertising
Senior Production/Studio Designer at leading creative agency delivering high-volume, high-quality digital assets for social media and eCommerce.
Automotive Creative Designer
Opportunities for contractors in various design roles within automotive industry. Join creative teams at Konzepthaus Consulting GmbH with locations in multiple cities.
Structural Designer IV
Structural Designer IV responsible for civil/structural design assignments at Hargrove. Assist in larger projects and ensure quality control of drafts with minimal supervision.
Game Designer
Game Designer creating engaging mobile games for Voodoo, a tech company with a mission to entertain. Lead game design for the TeamBlitz platform focusing on casual gaming experiences.
Senior Designer
Senior Designer crafting best-in-class digital commerce experiences for Shopify at ehouse Studio, LLC. Leading visual design and collaborating with cross-functional teams to optimize user experience.
Senior Application Designer
Senior Professional Application Designer at Gainwell creating complex software applications for healthcare clients. Driving innovative solutions to improve health and well-being of vulnerable communities across various technologies.