Content Solutions Analyst I

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

📋 Description

• Knowledge of claims payment and reimbursement methodologies, along with medical policy rules and edits.

• Proficient in analyzing intricate data and synthesizing it for both customer and internal use.

• Capable of performing effectively both independently and as part of a team in a fast-paced, demanding environment.

• Skilled in managing timelines and juggling multiple projects with high precision and attention to detail.

• Offer coding, claims processing, and industry expertise to aid in the development of clinical coding policies or pharmacy claims editing policies.

• Tasked with drafting business logic for new rules and enhancements by converting industry references into Cotiviti policy.

• Provide insights on any new or complex enhancements to the rule engine developers and system architects.

• Collaborate within the ART, specifically offering guidance and input to TPOs/developers during grooming sessions.

• Partner with Product and Go to Market teams to deliver coding and clinical expertise for the rollout of new policies.

• Ensure that internal Cotiviti operational teams have a clear understanding of the content solutions roadmap to maintain alignment on incoming work.

• Conduct multi-dimensional analytics for data and report assessments with minimal supervision.

⛳️ Requirements

• Bachelor’s degree in Nursing. Pharmacist (BSPharm or PharmD). Off-shore Medical or Pharmacy degree (MBBS or higher). Other Bachelor’s degree (or equivalent work experience).

• AND RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, CPhT OR a commitment to acquire certification within one year of employment.

• 3 years of experience in a clinical/retail setting as a nurse, pharmacist, or physician, OR 3 years of clinical coding experience in a payer setting.

• An additional 3 years of research experience related to coding (CPT, HCPCS, ICD, NDC) OR at least 3 years in an internal Cotiviti position (CPM, CSM, Content Analyst, etc.).

• 5 years of previous experience in detailed rule requirement gathering, rule development, and collaboration on software enhancements is required.

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

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

• Proficient in Microsoft Office Suite.

• Outstanding interpersonal, verbal, and written communication skills.

🏝️ 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) annually, depending on specific level and length of service with Cotiviti.