- 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
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client service associate - Remote, OR, United States - Cotiviti
Description
The Client Service Associate's (CSA) role is to ensure adequate support for the client-facing team on coding and policy-related activities. The CSA must be familiar with the day-to-day activities of the Client Policy Manager (CPM), Client Service Manager (CSM), and client-facing Medical Directors.
Other Related Responsibilities
MINIMUM QUALIFICATIONS:
JOB DEMANDS:
Base compensation ranges from $20.00 Hr. to $24.00 Hr. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our
Date of posting: 5/3/2024
Applications are assessed on a rolling basis. We anticipate that the application window will close on 7/3/2024, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
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