Medical Policy Director

Cotiviti

Medical Policy Director serving clients in medical payment policy at Cotiviti. Collaborating with client teams and coordinating medical policy presentations and optimizations.

Posted 5/26/2026full-timeRemote • 🇺🇸 United StatesLead💰 $120,000 - $145,000 per yearWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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, medical payment/policy editing applying Medicare, Medicaid, ICD, CPT, HCPCS and other specialty society guidelines preferred
Exceptional presentation, interpersonal, verbal and written communication skills
Superior organizational skills with the ability to work in a fast-faced environment, prioritize, and manage multiple competing deadlines with minimal direction
Strong problem-solving skills and an ability to think strategically
Ability to analyze complex data and synthesize it for general consumption
Excellent computer skills in Microsoft Word, Excel, PowerPoint, and Outlook are a must
Willingness/availability to travel 10-20% is required

Benefits

Comp & perks

medical, dental, 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

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

medical policy analysisclaim payment adjudicationdata analysispolicy editingpresentation preparationclient advocacystrategic thinkingproblem-solvingsynthesizing complex data

Soft Skills

interpersonal skillsverbal communicationwritten communicationorganizational skillstime managementtrust buildingcredibilityclient managementpresentation skills

Certifications

CPCCPC-ACCACCSCCS-PRHITRHIA