[Remote] Content Solutions Analyst I

Note: The job is a remote job and is open to candidates in USA. Cotiviti is a healthcare solutions company, and they are seeking a Content Solutions Analyst I to join their clinical operations and content team. The role involves researching, ensuring quality, and analyzing medical policies while providing support across various solutions in Payment Policy Management.

Responsibilities

• 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

Skills

• 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
• Experience supporting Behavioral Health and/or Laboratory payment integrity rule development, including coding research and rule logic application

Benefits

• Medical
• Dental
• Vision
• Disability
• 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

Company H1B Sponsorship