Medical Policy Testing Analyst I

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)

• Develops test scenarios to thoroughly test medical policies (Temp Rules, Switch Requests, and Change Requests).
• Analyzes and troubleshoots erroneous results, determines the root cause and suggests a solution.
• Communicates effectively and timely with upstream  functional areas to resolve issues.
• Maintains minimal error rate of less than 3 (Critical Omissions) per quarter.
• Conducts Regression Testing of medical polices to ensure client specific medical policy accuracy and quality.
• Evaluates Pre/Post test results of client files for accuracy and quality.
• Meets daily and monthly production and quality targets.
• Assists with Research Requests.
• Participates in other projects, as needed.
• Other duties as assigned. 

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

• Ability to learn and quickly apply new material
• Ability to adapt to changing situations with ease
• Ability to think "outside the box"
• Ability to work collaboratively to achieve results
• Self-starter, with strong confidence level
• Strong analytical and problem solving skills
• Experience in Microsoft Office (Excel, Word, PowerPoint), 2 years' minimum
• Professional with the 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
• Time management skills and have the ability to understand that much or the work we do is time sensitive
• Must be able to sit and use a computer keyboard for extended periods of time
• Ability to adjust schedule to meet release deadlines, as needed (evenings / weekends)
• Must have ability to positively handle / manage stress, such as high work volume and frequent change
• Must have flexibility and willingness to participate in the work processes or an international organization, including conference calls scheduled to accommodate global time zones.

Base compensation ranges from $22.50 to $27.50. 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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