Policy Configuration Analyst

The Medical Policy Analyst (for the Configuration Analyst role) is responsible for developing and

processing Rule Maintenance Requests (RMRs) and configuring the rules and tables associated with them for each release by the configuration cutoff date reflected on the Release Schedule. The MPA Configuration Analyst role is the entry level role within the department.

Key Responsibilities

Key Responsibilities

Successfully complete role specific training with a full understanding of work to be performed. Process RMRs to modify existing rule versions to ensure rules for iHT clients are configured in accordance with the guidelines, rule descriptions and instructions for each request. Process RMRs to Implement or create new rule versions to ensure rules for iHT clients are configured in accordance with the guidelines, rule descriptions and instructions on each request. Process 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 Tearoom, 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 and taking necessary steps to resolving the QA query if needed. Assists in the analysis and troubleshooting of erroneous results. Communicates effectively and timely with upstream functional areas to resolve issues. Maintains the following accuracy targets

in reference to rule configuration o95% Rule Configuration Accuracy o98% RMR Resolution

Accuracy o98% Rule Reference Accuracy Successfully and accurately performs table loads in JBPM. Other duties as assigned.

Core Competencies

Communicates with Impact

Presents information and ideas in a thoughtful and compelling manner; is clear and concise in verbal and written communications. Shares information freely and speaks openly and honestly. Seeks to understand the perspectives of others.

Drives and Delivers Results

Sets clear priorities, takes action, stays focused, and overcomes barriers to deliver expected results.

Leads Change

Sees emerging patterns and opportunities, and adapts quickly and easily to new information,

changing conditions or unexpected events. Facilitates and communicates change across the team or

organization to drive adoption.

Solves Problems and Makes Good Decisions

Evaluates critical information needed to understand problems, determine probable causes, and

develops workable solutions. Accurately assesses the costs, benefits, and risks associated with

alternative courses of action and makes high quality and timely decisions.

Lives Our Values

Behaves in a way that consistently demonstrates commitment to Cotiviti values.

Education

Degree Program of Study Required/Preferred

Bachelors Preferred

Educational Requirements

Bachelor’s Degree (or higher) preferred (or equivalent experience).

Certifications & Licensures

Certifications/Licensures Required/Preferred

Skills, Experience, and Other Requirements

Experience Requirements

Ability to learn and quickly apply new material.

Ability to adapt to changing situations with ease.

Quick leaner who is able to think “outside of the box”.

Ability to work collaboratively to achieve results.

Self-starter, with strong confidence level.

Strong analytical and problem-solving skills.

Ability to accurately perform responsibilities independently.

Proficient with Microsoft Office Suite (Word, Excel, Power Point).

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.

Ability to research and examine client questions to find the appropriate answer that includes the

appropriate reference to the client’s questions.

Time management skills and have the ability to understand that much of the work that we do is time sensitive.

Must be able to sit and use a computer keyboard for extended periods of time.

Must be able to lift up to 20 lbs without assistance.

Ability to adjust schedule to meet release deadlines, as needed (evenings, weekends).

No travel required for this role.

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 of an international organization, including conference calls scheduled to accommodate global time zones.