Medical Policy Analyst Cotiviti 100 reviews - Atlanta, GA Position Summary The Policy Configuration Specialist role is responsible for developing and processing Rule Maintenance Requests (RMRs) to implement Approved with Modification decisions within a Periodic Update, Prior Approval and New Policy Presentation for each release by the configuration cut-off date reflected on the Release Schedule. Key Responsibilities Translating client terminology into Cotiviti configuration lingo (and vice versa) Develop and process RMRs to implement new rules and new rule versions associated with Library and Custom rules using the Rules Maintenance Interface (RMI) Implement Health Plan Policy Temp Rules Develop and process RMRs to modify existing rule versions to ensure rules for Cotiviti clients are configured in accordance with the rule descriptions and instructions on each request Perform PU Analysis as requested for assigned payer (including policy interactions, reason code and sub-specialty mappings) Process RMRs in a timely manner ensuring each request is completed by the end of business on the Logical RMR Peer Review Cut Off date reflected on the Monthly Release Schedule. This responsibility includes actively monitoring the Medical Policy and Configuration queues in the RMR database to ensure all requests are processed for the appropriate Release Month Responsible for resolving Rule QA errors resulting from rule updates from implementing PU, PA or NPP Generates the PU audit report after switches have been completed to validate accuracy for Approved Library and Reject decisions Resolves testing issues and conflicts related to policy configuration rule updates from implementing PU, PA, NPP or HPP. Documents action taken for each RMR in the appropriate field of the RMR Communicates effectively and timely with upstream functional areas to resolve issues Maintains the following monthly stats for RMR Rework: 100% Exceeds; 99% Meets All Expectations; 98% Meets Most Expectations; 97% Meets Some Expectations; >97% Does not meet Expectations Maintains high level knowledge of CDM functionality Participates in client presentations for Periodic Updates and New Policy information Responsible for capturing client presentation decisions in CDM 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 executed per the clients intent Other duties as assigned Bachelors degree preferred or equivalent experience Ability to learn and quickly apply new material Ability to adapt to changing situations with ease Team player with strong desire to assist others and share knowledge Excellent analytical skills with ability to troubleshoot problems and find root causes 1 year of Cotiviti experience preferred Ability to think outside the box Ability to work collaboratively to achieve results Self-starter, with strong confidence level Strong analytical and problem solving skills Ability to accurately perform responsibilities independently Knowledge of CPT-4, ICD-9-CM, HCPCS coding, and medical terminology Experience in Microsoft Office (Excel, Word, PowerPoint), 2 year minimum Professional with ability to properly handle confidential information Ability to work well in a team environment Ability to handle multiple tasks, prioritize and meet deadlines Excellent written and verbal communication skills Proficient time management skills and the understanding that much of the work that we do is time sensitive Must be able to sit and use a computer keyboard for extended periods of time Able to lift up to 30lbs without assistance Ability to adjust schedule to meet release deadlines, as needed (evenings, weekends) Minimal travel required for this role 7 hours ago - save job - original job Apply On Company Site Other jobs you may like Medical Policy Analyst Cotiviti - Atlanta, GA 1 day ago Research Analyst State Farm - Atlanta, GA 4 days ago Research Analyst Epiq Systems, Inc.