Coordinates with US Research Medical Directors to manage the integrity of the Payment Policy Library and ensure the Payment Policy Library is accurate and up-to-date.
Supports the scheduled review process for State Medicaid policies in collaboration with the US Client Medical Directors and/or Client Policy Managers.
Responds to the research related queries pertaining to the medical policy raised by internal personnel or client including but not limited to:
Questions about claims edits that enforce medical policy.
Interpretation of how claims edits relate to policy statements.
Recommendations regarding modifications of edits.
Supports quarterly and annual updates in collaboration with the US Research Medical Directors.
Supports the scheduled review process for global and specialty policies in collaboration with the US Research Medical Directors.
Works diligently to meet and exceed productivity and quality benchmarks
Takes charge of ongoing learning and development and participates in relevant training and development activities
Collaborates well with global research team members to advance the Research agenda.
Supports other departments and client teams within Cotiviti on assigned project work.
Supports other Research related activities as assigned
ATTRIBUTES AND BEHAVIORS
Develops and maintains positive working relationships with others.
Shares ideas and information.
Assists colleagues unprompted.
Takes pride in the achievement of team objectives.
Has credibility with peers and senior managers.
Self-motivated – driven to achieve results.
Works with a sense of urgency.
High customer service ethic – is passionate about meeting customer expectations and improving service levels.
Keeps pace with change – acquires knowledge/skills as the business evolves.
Handles confidential information with sensitivity.
Exhibits behaviors consistent with Cotiviti Values:
Passionate Client Service
RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS
Medical degree (MBBS or BAMS or BHMS or BDS or B.P.Th)
Clearance of all major exams (SSC, HSC, qualifying degree) in first attempt.
Clearance of aptitude test for analytical, quantitative, and logical reasoning skills.
Clearance of English assessment test for both written and verbal skills.
Practical clinical experience working in a hospital/office or nursing home strongly preferred.
Experience in US healthcare specifically billing, coding and health plan operations strongly preferred.
Knowledge of ICD-10 coding preferred.
SKILLS & COMPETENCIES
Strong analytical, critical thinking and problem solving skills.
Excellent verbal and written communication skills.
Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads.
Ability to work well independently and maintain focus on a topic for prolonged periods of time.
Comfort in working with team members that are remote and located in the US, India or other geographies.
Ability to work within a matrix organization.
No direct reports.
Works with all Cotiviti business teams but especially Research (Medical Directors & Research Analysts), Medical Policy and Client Services.