Client Policy Manager

Cotiviti

. Manage client payment policies to ensure accuracy, currency, and completeness .

Posted 10/15/2026full-timeRemote • United StatesMid-LevelSenior💰 $78,000 - $106,000 per yearWebsite

About the role

Key responsibilities & impact

Manage client payment policies to ensure accuracy, currency, and completeness
Execute client-specific requests with guidance from internal teams and serve as an internal and external client team liaison
Maintain the integrity of client medical policy sets
Track client-related Medical Policy project requests
Conduct monthly reviews of Max Units and Health Plan rules
Drive Periodic Update analysis and industry updates
Identify and implement changes needed to keep client policies accurate and current
Prepare payment policy documents for client presentation
Review documents, coordinate reviews with Medical Directors, and participate in client policy meetings
Research and analyze medical policy items with guidance from the Cotiviti Client Medical Director and Content team
Review and articulate medical policies and present them for review and client acceptance
Document and maintain client medical policy sensitivities and nuances in the Client Profile Workbook
Communicate with internal and external client-team members
Perform multifaceted data and report analytics
Apply project management principles to initiate, create, and manage projects
Review and analyze client inquiries, apply decisions to affected policies, maintain information, and communicate outcomes
Complete Performance Plan responsibilities, special projects, and other assigned duties

Requirements

What you’ll need

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, preferably in a payer setting
Strong knowledge of healthcare claims payment policy and processing, including CMS, Medicaid, ICD, CPT, HCPCS and specialty society standards
Experience in claims adjudication or utilization review for a managed care or healthcare insurance company
Familiarity with claims payment and reimbursement methodologies
Experience in customer service or client management in a healthcare setting
Strong knowledge of CMS guidelines, health plans, managed care or healthcare insurance company operations
Prior experience developing medical payment policy edits
Proficiency in Microsoft Office suite
Demonstrated problem-solving skills
Ability to properly handle confidential information
Ability to work independently and collaboratively in a fast-paced, demanding environment
Ability to analyze data and synthesize it for customer and internal consumption
Effective verbal and written communication and interpersonal skills
Ability to manage timelines and multiple projects, prioritize and meet deadlines
Flexibility and willingness to participate in an international organization’s work processes, including conference calls across global time zones
Must be able to perform duties with or without reasonable accommodation
Must be able to lift up to 20 lbs without assistance
Must be able to sit and use a computer keyboard for extended periods
Must be able to provide a dedicated, secure work area
Must be able to provide high-speed internet access/connectivity and office setup and maintenance

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
Disability insurance
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
Remote work
Flexible scheduling to accommodate global time zones
Up to 20% travel requirement
Employer-provided benefits package