Policy Configuration Analyst I

Overview:

The Policy Configuration Analyst role is responsible for developing and processing Rule Maintenance Requests (RMRs) and configuring the rules associated with them for each release by the configuration cutoff date reflected on the Release Schedule.

• Translating client terminology into Cotiviti configuration lingo (and vice versa).
• Processes Ad-Hoc PR’s in a timely manner ensuring each request is completed by the PR Cut Off date reflected on the Release Schedule.
• Successfully complete additional PR training for more complex client needs, which includes, Complex Max Units loads, CCI Deviations, Named Set Table loads, Mappings, and any additional work as required.
• Actively monitoring the PR queues in the PRMs database to ensure all requests are processed for the appropriate Release Month.
• Processes client switches associated to the Ad-Hoc PR’s in a timely manner ensuring each switch is completed by the Switch Management Cut Off date reflected on the Release Schedule.
• Develops and processes RMRs to modify existing rule versions to ensure rules for Cotiviti clients are configured in accordance with the rule descriptions and instructions on each request.
• Processes RMRs in a timely manner ensuring each request is completed by the Configuration Cut Off date reflected on the Release Schedule. This responsibility includes actively monitoring the Configuration queues in the RMRs database to ensure all requests are processed for the appropriate Release Month.
• Configure rules and tables in accordance with configuration guidelines contained in the appropriate Teamroom, training document, departmental job aids or Process Guidelines reflected in the Document Management System (DMS).
• Documents action taken for each RMR in the appropriate field of the RMR.
• Runs QA for each rule associated with RMRs processed. This includes running QA for each RMR reviewed when performing Peer Review responsibilities.
• Assists in the analysis and troubleshooting of erroneous results.
• Review and complete Research Requests associated to the Rule QA report.
• Communicates effectively and timely with upstream functional areas to resolve issues.
• Maintains the following accuracy targets in reference to rule configuration –
  • 95% Rule configuration accuracy
  • 98% RMR resolution accuracy
  • 98% Rule Reference accuracy
  • 80% RMR creation accuracy
• Meets daily and monthly production and quality targets; maintaining an exemplary level of accuracy in all work; ensuring that the capture and completion of assigned projects are QA’d per policy and corrections are made if needed.
• Maintains working knowledge of CDM functionality.
• Successfully and accurately performs table loads.
• Other duties as assigned.
• Point Release Assistance.

• Bachelor’s degree preferred or equivalent experience.
• Prefer CPC, CCS, or RHIA certification.
• Ability to learn and quickly apply new material.
• Ability to adapt to changing situations with ease.
• Team player with strong desire to assist others and share knowledge.
• Excellent analytical skills with ability to troubleshoot problems and find root causes.
• 1-year Cotiviti experience or industry experience.

Job Demands:

• This is a work at home position.  Access to high speed internet is required (all other equipment will be provided). 
• No travel required. 
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
• After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent).
• Must have ability to positively handle/manage stress, such as high work volume and frequent change.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• 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.

Base compensation ranges from $19.50 to $23.00 per hour. 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.

Date of posting: 1/10/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 3/10/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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