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Medical Policy Testing Analyst I

Company

Cotiviti
Address , Remote
Employment type FULL_TIME
Salary $22.80 - $26.90 an hour
Expires 2023-10-17
Posted at 8 months ago
Job Description
Overview:
The Medical Policy Analyst (for the Policy Testing Analyst role) is responsible for testing Medical Policies to ensure product integrity, accuracy and quality. This role serves as a checkpoint by running test scenarios to ensure the medical policies invoke appropriately, and are in line with each client’s policy.

This area of our business allows a lot of opportunity for advancement and the Medical Policy team will be considering candidates that are looking to start their career in the corporate healthcare space and is a recent college graduate OR candidates that have been working in healthcare claims, medical policy, or other similar experience.

Responsibilities:
Key Responsibilities (after training)
  • Meets daily and monthly production and quality targets.
  • Conducts Regression Testing of medical polices to ensure client specific medical policy accuracy and quality.
  • Participates in other projects, as needed.
  • Other duties as assigned.
  • Communicates effectively and timely with upstream functional areas to resolve issues.
  • Evaluates Pre/Post test results of client files for accuracy and quality.
  • Assists with Research Requests.
  • Analyzes and troubleshoots erroneous results, determines the root cause and suggests a solution.
  • Develops test scenarios to thoroughly test medical policies (Temp Rules, Switch Requests, and Change Requests).
  • Maintains minimal error rate of less than 3 (Critical Omissions) per quarter.
Qualifications:
Education Requirements
  • Bachelors Degree or equivalent work experience preferred
Preferred Experience:
  • Health plan operations experience working with medical policies, edits, or claims.
Skills, Experience or Other Requirements
  • Must be able to sit and use a computer keyboard for extended periods of time
  • Must have ability to positively handle / manage stress, such as high work volume and frequent change
  • Professional with the ability to properly handle confidential information
  • Experience in Microsoft Office (Excel, Word, PowerPoint), 2 years' minimum
  • Ability to think "outside the box"
  • Self-starter, with strong confidence level
  • Ability to work collaboratively to achieve results
  • Time management skills and have the ability to understand that much or the work we do is time sensitive
  • Ability to adjust schedule to meet release deadlines, as needed (evenings / weekends)
  • Ability to adapt to changing situations with ease
  • Excellent written and verbal communication skills
  • Strong analytical and problem solving skills
  • Must have flexibility and willingness to participate in the work processes or an international organization, including conference calls scheduled to accommodate global time zones.
  • Ability to handle multiple tasks, prioritize and meet deadlines
  • Ability to learn and quickly apply new material
  • Ability to work well independently and in a team environment
Base compensation ranges from $22.80 to $26.90. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

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