Content Solutions Analyst I

Responsibilities

• Familiarity with claims payment and reimbursement methodologies as well as medical policy rules and edits.
• Ability to analyze complex data and synthesize it for customer and internal consumption.
• Ability to work well both independently and collaboratively, in a fast-paced and demanding environment.
• Effective at managing timelines and multiple projects with high accuracy and attention to detail.
• Provide coding, claims processing and industry expertise to help create clinical coding policy or pharmacy claims editing policy.
• Responsible for writing business logic for new rules and enhancements by translating industry references into Cotiviti policy.
• Provide input on any new, or complex enhancements to the rule engine developers as well as system architects.
• Work within the ART, specifically providing guidance and input to TPO’s/developers during grooming sessions.
• Work with Product and the Go to Market teams, to provide coding and clinical expertise for new policy rollout.
• Ensure internal Cotiviti operational teams have a clear vision and understanding of the content solutions roadmap to ensure lock step on incoming work.

Qualifications

• Education & Certification: BS in Nursing. Pharmacist (BSPharm or PharmD). Off-shore Medical or Pharmacy degree (MBBS or higher). Other Bachelors degree (or equivalent work experience). AND RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, CPhT OR willingness to obtain certification within one year of employment.
• Experience: 3 years in clinical/retail setting as nurse, pharmacist, or physician, OR 3 years clinical coding in payer setting. An additional 3 years research experience related to coding (CPT, HCPCS, ICD, NDC) OR at least 3 years in an internal Cotiviti role (CPM, CSM, Content Analyst, etc.). 5 years previous experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements required.
• Experience 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 skills.
• Proficiency in Microsoft Office Suite.
• Excellent interpersonal, verbal and written communication skills.