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Medical Policy Director

Cotiviti, Inc. • South Jordan, UT • 23h ago

Job Locations

US-Remote

2026-18561

Category

Client Services

Position Type

Full-Time

Overview

The Medical Policy Director (MPD) is a key member of the Go To Market team. Along with the Client Engagement Leader, Client Medical Director (CMD), the MPD co-captains the team serving the Prospective Payment Management (PPM) client team at the health plan. The MPDs role is to serve as a coding and medical payment policy subject matter expert (SME), with the assistance of a CMD. The MPD is responsible for directing the Medical Policy Committee (joint committee with health plan MD, coding experts, and payment integrity). The MPD will develop a relationship with the client, review their data, select medical policy to present, serve as SME for clinical and coding expertise, and back-end support for Cotiviti's and the client's Medical Directors. The MPD will evolve as the trusted advisor for the Health Plan in terms of medical payment policy.

Responsibilities

Act as a knowledgebase expert regarding the Cotiviti Medical Policy library.

Gain an understanding of each client's unique lines of business, medical policy standards and system configuration strategy to inform optimization opportunities.

Analyze client data and identify new medical policy opportunities for presentation including valuation and validation of editing.

Examine and select specific claim examples to utilize in a presentation to the client to support the understanding of the new medical policy.

Prepare various documents and presentation materials for use during internal payment policy committee meetings and/or client meetings.

Review all documents and coordinate reviews with the CMD to evaluate and validate the editing and financial impact.

Confidently perform client policy presentations to highlight the facts of each rule, the data that supports the policy recommendation, the impact to claims processing, and the associated value.

Successfully advocate for the adoption of new medical policies by clients to optimize the value Cotiviti offers.

Participate in client meetings as required as a medical policy subject matter expert.

Coordinate with the internal client team to ensure that all requested follow-up items are delivered to the client.

Inspire trust and credibility with clients.

Communicate effectively across various organizational levels and members of the internal and external client teams.

Assist in identifying opportunities for other Cotiviti product solutions.

Complete all responsibilities as outlined in the annual performance review and/or goal setting.

Complete all special projects and other duties as assigned.

Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.

Qualifications

Bachelor's Degree in a relevant field or equivalent.

Professional coder certification required (CPC, CPC-A, CCA, CCS, or CCS-P), RHIT or RHIA certification a plus.

Minimum of 7-10 years of work experience, preferably in sales, customer service or client management.

Minimum of 5 years of experience in claim payment adjudication, m

edical payment/policy editing applying Medicare, Medicaid, ICD, CPT, HCPCS and other specialty society guidelines preferred.

Health plan, managed care or health insurance experience preferred.

Exceptional presentation, interpersonal, verbal and... For full info follow application link.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

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