Hiring: Client Policy Manager Company: Cotiviti Location: United States Job Posted Time: 2026-09-10 13:44:37 Employment Type: Remote Target Skills & Keywords : CPT, Medicaid, Microsoft Office, Utilization Review About the job Experience: •3 years clinical coding experience, preferable in a payer setting. Required Skills: •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. 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. •Operational familiarity with claims payment and reimbursement methodologies. •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. •Professional with ability to properly handle confidential information. Compensation: •$78,000 - $106,000 / year •Flexible work environment (work from home / hybrid options) •Competitive benefits and rewards package Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!