Concept Development Analyst – Automated Concepts

📋 Description

• Assist in the enhancement and continuous optimization of claim selection processes and tools.

• Utilize extensive clinical, coding, analytical, and reimbursement knowledge to reinforce and operationalize current selection strategies.

• Play a key role in advancing proprietary claim selection tools that promote accurate, compliant, and scalable payment integrity outcomes.

• Offer coding guidance, analytical insights, and validation to support model development, tuning, and evaluation of outputs.

• Evaluate selection outputs and implement meaningful actions based on audit performance trends.

⛳️ Requirements

• A minimum of 5 years of experience in data analytics, medical billing, inpatient and outpatient coding, auditing, or Clinical Documentation Improvement (CDI).

• A Bachelor’s or Graduate degree is required.

• Proficient in at least one area, with a willingness to learn others as necessary: Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), Emergency Room, Behavioral Health.

• Proficiency in Microsoft Excel is essential.

• Capable of conducting basic data analyses independently.

• Comprehensive understanding of healthcare coding systems and payment methodologies (CPT, HCPCS, ICD-10, HIPPS, and Revenue Codes, etc.).

• AAPC or AHIMA coding certification is preferred.

• Familiarity with healthcare claim adjudication standards and procedures.

• Exceptional verbal and written communication skills.

• Strong analytical and investigative capabilities.

• Basic knowledge of HIPAA Privacy and Security Rules and CMS security requirements.

• Ability to work autonomously, prioritize tasks, and document progress effectively.

• Previous auditing or consulting experience in either a provider or payer setting is desirable.

• Experience with AI-enabled tools (e.g., ChatGPT, Copilot, or similar) is a plus.

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• Disability insurance

• Life insurance

• 401(k) retirement plan

• Paid family leave

• 9 paid holidays per year

• 17-27 days of Paid Time Off (PTO) per year, based on specific level and length of service with Cotiviti