This new and evolving position includes diverse responsibilities such as assisting with the alignment in the Outpatient Specialty (OPSP) policies across Commercial and Government and assisting with project work by leveraging skills in Excel, Visio, and PowerPoint, and coordinating with other departments.

The Project Manager will also analyze various data sources and offer and help implement ideas for process improvement. This role will help to identify efficiencies during the development, testing and initial production phases of new systems. Knowledge sharing and fostering a collaborative environment are important in this role. 

• Ensure consistent application of OPSP policies across both Commercial and Government clients by collaborating with key areas such as Content, Training and Appeals. This includes addressing new policy changes identified during the CMS Q6 process or QA/Appeals feedback.
• Utilize project management skills to develop and manage project documents and presentations using tools like Excel, Visio, and PowerPoint.
• Create and maintain project status documents and conduct regular status meetings to keep projects on track. Foster efficient teamwork, track lessons learned and share insights with team members.
• Perform analysis and monitoring of various Key Performance Indicator (KPI) reports to drive continuous improvement.
• Recommend and track system or process improvements to boost productivity, quality or cost containment.
• Monitor system issues for IT escalation. Analyze trends and root causes of issues and downtime to identify areas of process improvement.
• Assisting in ensuring operational controls are in place to meet client budget goals. Monitor selections to promptly identify staffing and training needs, ensuring timely completion of claims.
• Complete all special projects and responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. 

• Bachelor’s degree in Health Information Management or nursing (with active / unrestricted) license. These degrees are preferred.
• Coding or Clinical Documentation Certification required i.e. CCDS, CPC, CIC, CCS, RHIA or RHIT (those without a coding certification will be asked to achieve one).
• 5+ years of related experience in a healthcare billing office or claims management role Related to the following areas: DRG Validation (MS, AP, or APR DRGs), APC/ASC Validation, Outpatient Review Types (Procedural Services, Physician Services, Emergency Department, Diagnostics and/or Laboratory Services).
• Prior Healthcare Billing and/or claims experience desired but not required.
• Requires working knowledge of and applicable industry-based standards.
• Ability to work well in an individual and team environment.
• Strong written and verbal communication skills with excellent interpersonal skills.
• Computer proficiency in Microsoft Excel, Access, Visio, PowerPoint and system databases are required.
• Experience managing project life cycle from initial proof of concept through approval, development, delivery, and implementation.
• Ability to build relationships across teams and other departments to facilitate successful delivery of projects.

Cognitive/Mental Requirements:

• Communicating with others to exchange information
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.

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 high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Base compensation ranges from $94,000 to $114,000 per year. 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: 6/24/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 8/24/2025, 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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