Note: The job is a remote job and is open to candidates in USA. Cotiviti is seeking a Content Solutions Analyst I to support its clinical operations and payment policy management functions. The role focuses on research, quality assurance, analytics, coding expertise, and development of medical policies, rules, and algorithms, particularly for genetics and laboratory services.
Responsibilities
- The Content Solutions Analyst I is a key member of the clinical operations and content team responsible for the research, quality assurance, and opportunity analysis associated with new medical policies
- In addition, this position will be responsible for review and analysis of current medical policies and 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
- This position requires maximum guidance from mentors and leadership
- Perform multi-faceted analytics for data and report analysis with minimal direction
Skills
- * BS in Nursing
- * Pharmacist (BSPharm or PharmD)
- * Off-shore Medical or Pharmacy degree (MBBS or higher)
- * Nationally recognized coding credential through AHIMA or AAPC - CCS, CPC, etc. REQUIRED
- * 5+ years in coding/billing experience for a large lab that performs genetic testing and other unrelated lab services
- * Expert in all aspects of genetics and lab coding, and able to provide education/support to clinical professionals (Genetic Counselors & others)
- * 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.)
- * 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
- * Other Bachelors degree (or equivalent work experience). PREFERRED
- * 5 years previous experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements preferred
- * Experience supporting Laboratory payment integrity rule development, including coding research and rule logic application, is preferred
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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