Note: The job is a remote job and is open to candidates in USA. Cotiviti is a healthcare technology company focused on payment policy management, and they are seeking a Content Solutions Analyst I. This role is responsible for research and analysis of medical policies, providing expertise in coding and claims processing, and contributing to the development of new clinical coding policies.
Responsibilities
- Research, quality assurance, and opportunity analysis associated with new medical policies
- Review and analysis of current medical policies
- Assisting in the research necessary to define additional logic and algorithms to expand the Cotiviti payment policy library
- Provide coding, claims processing and industry expertise to help create clinical coding policy or pharmacy claims editing policy
- Responsible for writing business logic for new rules and enhancements by translating industry references into Cotiviti policy
- Provide input on any new, or complex enhancements to the rule engine developers as well as system architects
- Work within the ART, specifically providing guidance and input to TPO’s/developers during grooming sessions
- Work with Product and the Go to Market teams, to provide coding and clinical expertise for new policy rollout
- Ensure internal Cotiviti operational teams have a clear vision and understanding of the content solutions roadmap to ensure lock step on incoming work
- Perform multi-faceted analytics for data and report analysis with minimal direction
Skills
- Familiarity with claims payment and reimbursement methodologies as well as medical policy rules and edits
- Ability to analyze complex data and synthesize it for customer and internal consumption
- Ability to work well both independently and collaboratively, in a fast-paced and demanding environment
- Effective at managing timelines and multiple projects with high accuracy and attention to detail
- Provide coding, claims processing and industry expertise to help create clinical coding policy or pharmacy claims editing policy
- Responsible for writing business logic for new rules and enhancements by translating industry references into Cotiviti policy
- Provide input on any new, or complex enhancements to the rule engine developers as well as system architects
- Work within the ART, specifically providing guidance and input to TPO's/developers during grooming sessions
- Work with Product and the Go to Market teams, to provide coding and clinical expertise for new policy rollout
- Ensure internal Cotiviti operational teams have a clear vision and understanding of the content solutions roadmap to ensure lock step on incoming work
- This position requires maximum guidance from mentors and leadership
- Perform multi-faceted analytics for data and report analysis with minimal direction
- BS in Nursing
- Pharmacist (BSPharm or PharmD)
- Off-shore Medical or Pharmacy degree (MBBS or higher)
- Other Bachelors degree (or equivalent work experience)
- RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, CPhT OR willingness to obtain certification within one year of employment
- 3 years in clinical/retail setting as nurse, pharmacist, or physician, OR 3 years clinical coding in payer setting
- An additional 3 years research experience related to coding (CPT, HCPCS, ICD, NDC) OR at least 3 years in an internal Cotiviti role (CPM, CSM, Content Analyst, etc.)
- 5 years previous experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements required
- Strong analytical, critical thinking and problem-solving skills
- Proficiency in Microsoft Office Suite
- Excellent interpersonal, verbal and written communication skills
- Must have flexibility and willingness to participate in the work processes of an international organization
- After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent)
- Communicating with others to exchange information
- Assessing the accuracy, neatness, and thoroughness of the work assigned
- 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
- No adverse environmental conditions expected
- Experience supporting Behavioral Health and/or Laboratory payment integrity rule development, including coding research and rule logic application
Benefits
- Medical, dental, vision, disability, and life insurance coverage
- 401(k) savings plans
- Paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti
Company Overview
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