Content Analyst II – Medicaid

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

📋 Description

• Conduct research, ensure quality assurance, and carry out opportunity analysis related to new medical policies.

• Evaluate and assess existing medical policies.

• Investigate and establish additional logic and algorithms to enhance the Cotiviti payment policy library, specifically focusing on Medicaid.

• Provide coding and industry expertise to develop and sustain clinical coding edits.

• Create business logic for new regulations and improvements by converting industry references into Cotiviti policy.

• Recognize changes in medical policies to keep an up-to-date and accurate medical policy library.

• Collaborate with client teams to offer coding and clinical expertise for customer and provider inquiries, questions, challenges, and appeals concerning clinical rules.

• Take ownership and accountability for assigned medical policies.

• Conduct comprehensive data and report analysis with minimal supervision.

• Mentor and guide new team members.

• Perform quality assurance on policy reviews, logic modifications, and research requests completed by colleagues.

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

⛳️ Requirements

• One of the following qualifications is required: An active professional license as a Registered Nurse; Pharmacist (BSPharm or PharmD); Bachelor’s degree in a healthcare-related field; Offshore Medical Degree (MBBS or higher).

• Professional certification (RHIA, RHIT, CPC, CPC-H, CPC-P, or CCS-P) is preferred or a willingness to obtain certification within one year of employment.

• A minimum of 5 years of experience in a clinical environment as a nurse, pharmacist, or physician, or at least 6 years of clinical coding experience, preferably within a payer setting.

• At least 3 years of experience in internet-based research related to CPT, HCPCS, ICD, or NDC codes.

• Strong knowledge of Medicaid guidelines is highly preferred.

• Familiarity with claims payment and reimbursement methodologies, medical policy rules, and edits.

• Capability to analyze complex data and synthesize it for both customer and internal use.

• Ability to operate independently and collaboratively in a fast-paced, challenging environment.

• Competence in managing timelines and multiple projects with a high degree of accuracy and attention to detail.

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

• Proficiency in the Microsoft Office suite.

• Excellent interpersonal, verbal, and written communication skills.

• Must be able to provide a dedicated, secure work area.

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

• Availability for after-hours and/or weekend work as needed for major deliverables/deadlines.

🏝️ Benefits

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

• Participation in a 401(k) savings plan.

• 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.

• Provision of a dedicated, secure work area.

• High-speed internet access/connectivity and maintenance of office setup.