Content Analyst II – Drug and Biological Policy

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct research, ensure quality, and manage the existing Drug and Biological policies.

• Develop additional logic and algorithms to enhance the D&B Library, providing added value for clients.

• Offer coding and industry expertise in the creation and maintenance of clinical coding edits.

• Draft business logic for new rules and improvements by converting industry references into Cotiviti policy.

• Review and identify necessary changes to keep the medical policy library accurate and up to date.

• Collaborate with client teams on coding and clinical inquiries, challenges, requests, and appeals regarding clinical rules.

• Take ownership and accountability for designated D&B policies.

• Mentor and train new team members effectively.

• Assist colleagues with policy reviews, logic modifications, and research requests to ensure precision.

• Stay informed about industry trends and Cotiviti content, best practices, applications, procedures, and policies.

• Complete special projects and additional responsibilities as assigned.

• Engage in international organization processes, including conference calls across global time zones.

• Uphold confidentiality and security of data.

⛳️ Requirements

• Possession of an active professional license as a Pharmacist (BSPharm or PharmD).

• Over 5 years of experience working as a pharmacist.

• Minimum of 3 years of experience in a specialty, clinical, or bedside environment.

• At least 3 years of experience in medical policy or prior authorization within a health plan setting is preferred.

• Proficient in internet-based research related to drug information and coding (CPT, HCPCS, ICD, or NDC).

• Understanding of claims payment and reimbursement methodologies.

• Capability to analyze and synthesize data for internal use.

• Ability to manage timelines and multiple projects with high accuracy and attention to detail.

• Strong analytical, critical thinking, and problem-solving abilities.

• Proficiency in Microsoft Office Suite.

• Preferred knowledge of Excel, including PivotTable and functions for data analysis.

• Exceptional interpersonal, verbal, and written communication skills.

• Professional certification (AHIMA or AAPC) preferred, or willingness to obtain certification within one year of employment.

• Access to high-speed internet is required.

• Flexibility to participate in global organizational processes and conference calls across different time zones.

• Ability to perform duties with or without reasonable accommodation.

• Must provide a dedicated and secure work environment.

• Must ensure high-speed internet access/connectivity and maintain an office setup.

• Must be capable of sitting and using a computer keyboard for extended durations.

• Must be able to remain stationary, often standing or sitting for long periods.

• Must be able to perform repetitive wrist, hand, and/or finger motions.

• Commitment to Cotiviti's values, information security, compliance, confidentiality, and data protection.

🏝️ Benefits

• Coverage for medical, dental, vision, disability, and life insurance.

• 401(K) savings plans.

• Paid family leave.

• 9 paid holidays each year.

• 17-27 days of Paid Time Off (PTO) annually, depending on specific level and length of service.

• All necessary equipment will be provided.

• Equal employment opportunity employer.