The Policy Inquiry Analyst is responsible for creating a consistent and unified voice for responding to client inquiries both accurately and in a timely manner. This position is achieved through continuous claims knowledge, demonstrated medical policy expertise, teamwork, knowledge sharing, organizational skills and high quality performance.
Key Responsibilities:
Reviews and analyzes client inquiries via CIRTS and provide a clear, precise, and complete client friendly response
Follow established guidelines for turnaround time and quality as defined in the Policy Inquiry Policy and Procedure Manual
Expertise in the Policy Inquiry application (SQUISH), rule configuration application (RMI), rule tracking tool (RMR), BRAT, and Testing
Communicate effectively and timely with functional areas to resolve inquiries
Attend all required team meetings
Other duties as assigned
Ability to provide accurate response with minimal assistance
Completes/participate in special projects as assigned
Requirements:
Works with a sense of urgency
Prior health plan operations experience helpful
Communicates with ease up and down the chain of leadership
Strong analytical and problem solving skills
Minimum of 2 years health claims experience (preferred)
Experience in processing Healthcare claims/knowledge of the claims process
Thorough understanding and knowledge of CPT, ICD, and HCPCS codes
Thorough understanding and knowledge of Medical Terminology
Strong organizational skills
Strong computer skills
Professional with ability to properly handle confidential information
Ability to work well independently and in a team environment
Ability to handle multiple tasks, prioritize and meet deadlines
Excellent written and verbal communication skills
Exhibits behaviors consistent with Cotiviti Values
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
