Content Solutions Analyst I, Certified Lab Coder

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

📋 Description

• Conduct research, ensure quality assurance, and assess opportunities related to new medical policies.

• Evaluate and analyze existing medical policies.

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

• Assist in Payment Policy Management solutions for outpatient, inpatient, genetics, pharmacy, fraud, and dental sectors.

• Offer coding, claims processing, and industry expertise to develop clinical coding or pharmacy claims-editing policies.

• Formulate business logic for new rules and updates by converting industry references into Cotiviti policy.

• Provide insights on complex enhancements to rule-engine developers and system architects.

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

• Collaborate with Product and Go-to-Market teams on the introduction of new policies.

• Ensure that internal operational teams comprehend the content-solutions roadmap and upcoming tasks.

• Conduct comprehensive data and report analysis with minimal supervision.

⛳️ Requirements

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

• A nationally recognized coding credential from AHIMA or AAPC—CCS, CPC, etc. is preferred and required.

• Over 5 years of coding/billing experience in a large laboratory conducting genetic testing and other unrelated laboratory services.

• In-depth knowledge of genetics and laboratory coding.

• Capability to educate and support clinical professionals, including Genetic Counselors.

• An additional 3 years of research experience associated with coding (CPT, HCPCS, ICD, NDC), or at least 3 years in an internal Cotiviti position.

• Experience in thorough rule requirement gathering, rule development, and collaboration on software enhancements is preferred.

• Experience in supporting laboratory payment integrity rule development, encompassing coding research and rule logic application, is preferred.

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

• Proficiency in Microsoft Office Suite.

• Exceptional interpersonal, verbal, and written communication skills.

• Flexibility and readiness to engage in the processes of an international organization.

• Willingness to work after hours and/or weekends when necessary to meet significant deadlines or deliverables.

• Ability to provide a secure, dedicated work environment.

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

🏝️ Benefits

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance coverage.

• Life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays annually.

• 17–27 days of Paid Time Off (PTO) each year, depending on specific level and duration of service.

• Remote work arrangement.

• Secure dedicated work area and high-speed internet/office setup required for remote work.