Client Policy Manager

Cotiviti

Client Policy Manager maintaining medical payment policies for Cotiviti’s healthcare claims-accuracy solutions. Analyzing claims rules, coordinating Medical Director reviews, and supporting payer clients.

Posted 8/19/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $78,000 - $106,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing client payment policies and conducting medical policy research and analysis, ensuring compliance with healthcare standards and effective communication with internal and external stakeholders. Proficient in project management and data analytics to support client needs and policy development.

Highest-signal resume keywords

Registered Nurse LicenseClinical Coding ExperienceHealthcare Claims Payment PolicyProfessional Coder CertificationData Analysis and Reporting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical CodingMedical Policy ResearchClaims AdjudicationUtilization ReviewPayment Policy DevelopmentData AnalyticsProject ManagementHealthcare Standards ComplianceMicrosoft Office SuiteConfidential Information Handling

Soft Skills

Effective CommunicationProblem-SolvingCollaborationTime ManagementInterpersonal Skills

Certifications & Qualifications

Registered Nurse LicenseProfessional Coder Certification

Industry Keywords

CMS GuidelinesMedicaidICDCPTHCPCSManaged CareHealthcare InsuranceClaims Payment MethodologiesClient ManagementHealthcare Claims Processing

About the role

Key responsibilities & impact

Manage client payment policies to ensure they are accurate, up-to-date and complete
Execute client-specific requests with guidance from the internal team and act as the internal and external client team liaison
Maintain the integrity of the client’s medical policy set
Track client-related medical policy project requests and conduct monthly reviews of Max Units and Health Plan rules
Drive Periodic Update analysis and industry updates
Review and identify changes needed to client policies
Prepare payment policy documents for client presentation
Coordinate document reviews with Medical Directors and participate in client policy meetings
Conduct medical policy research and analysis with guidance from Cotiviti Client Medical Director and Content
Review client payment policies for accuracy and timeliness
Clearly understand and articulate medical policies and present them to the Cotiviti Client Medical Director for review and client acceptance
Provide direction regarding client understanding of medical policies
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, determine affected policies, maintain information and communicate decisions to clients
Complete annual 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 a 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
Experience with health plans, managed care or healthcare insurance companies
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 accommodating 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 level and length of service
Remote work
Up to 20% travel requirement
Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance provided by the employee