Content Solutions Analyst I

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

📋 Description

• Conduct research on new medical policies and execute quality assurance along with opportunity analysis.

• Evaluate and analyze existing medical policies.

• Investigate and articulate logic and algorithms to enhance Cotiviti’s payment policy library.

• Assist in the management of payment policy solutions for outpatient, inpatient, pharmacy, fraud, and dental sectors.

• Analyze intricate data and consolidate findings for clients and internal teams.

• Offer coding, claims processing, and industry knowledge for clinical coding and pharmacy claims editing policies.

• Develop business logic for new regulations and improvements by converting industry references into Cotiviti policies.

• Provide insights to rule engine developers and system architects regarding new or complicated enhancements.

• Mentor and advise TPOs/developers during ART grooming sessions.

• Work collaboratively with Product and Go to Market teams on the rollout of new policies.

• Relay the content solutions roadmap to internal operational teams at Cotiviti.

• Carry out multifaceted analytics for data and report analysis with minimal oversight.

⛳️ Requirements

• Bachelor's degree in Nursing; Pharmacist (BSPharm or PharmD); offshore Medical or Pharmacy degree (MBBS or higher); or another Bachelor’s degree (or equivalent work experience).

• Certification such as RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, or CPhT, or a commitment to obtain certification within one year of employment.

• Minimum of 3 years in a clinical/retail environment 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 a role at Cotiviti.

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

• Preferred experience in supporting Behavioral Health and/or Laboratory payment integrity rule development.

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

• Proficient in Microsoft Office Suite.

• Exceptional interpersonal, verbal, and written communication skills.

• Willingness to adapt and participate in the work processes of an international organization.

• Availability for after-hours and/or weekend work when necessary for significant deliverables and deadlines.

• Capability to provide a dedicated, secure workspace.

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

• Ability to remain in a stationary position, frequently standing or sitting for extended periods.

• Capability to perform repetitive motions involving wrists, hands, and/or fingers.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Disability insurance.

• Life insurance coverage.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays per year.

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

• Remote work arrangement.

• Dedicated secure workspace and support for high-speed internet/office setup required.