Content Solutions Analyst I (Certified Lab Coder)

About the role

The Content Solutions Analyst I is a key member of the clinical operations and content team responsible for research, quality assurance, and opportunity analysis associated with new medical policies. This position also reviews and analyzes current medical policies and assists in defining additional logic and algorithms to expand the Cotiviti payment policy library. The Content Solutions team supports all PPM Solutions: outpatient, inpatient, genetics, pharmacy, fraud, and dental. This role primarily works within the Genetics/Lab Content Team and requires an experienced certified lab coder to support medical policy and edit development. While the role is intended for the Genetics/Lab team, there is no expectation to work exclusively within one solution; flexibility to work across all solutions is required.

Responsibilities

• Apply familiarity with claims payment and reimbursement methodologies, as well as medical policy rules and edits.
• Analyze complex data and synthesize it for customer and internal consumption.
• Work independently and collaboratively in a fast-paced, demanding environment.
• Manage timelines and multiple projects with high accuracy and attention to detail.
• Provide coding, claims processing, and industry expertise to create clinical coding or pharmacy claims editing policy.
• Write business logic for new rules and enhancements by translating industry references into Cotiviti policy.
• Provide input on new or complex enhancements to rule engine developers and system architects.
• Work within the ART, providing guidance and input to TPOs/developers during grooming sessions.
• Collaborate with Product and Go-to-Market teams to provide coding and clinical expertise for new policy rollouts.
• Ensure internal Cotiviti operational teams have a clear understanding of the content solutions roadmap to align on incoming work.
• Perform multi-faceted analytics for data and report analysis with minimal direction.

Requirements

• 5+ years of coding/billing experience for a large lab that performs genetic testing and other unrelated lab services.
• Expertise in all aspects of genetics and lab coding, with the ability to provide education and support to clinical professionals (e.g., Genetic Counselors).
• An additional 3 years of 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 of experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements (preferred).
• Experience supporting Laboratory payment integrity rule development, including coding research and rule logic application (preferred).
• Strong analytical, critical thinking, and problem-solving skills.
• Proficiency in Microsoft Office Suite.
• Excellent interpersonal, verbal, and written communication skills.
• Flexibility and willingness to participate in the work processes of an international organization.
• Ability to work after hours and/or weekends as needed for major deliverables or deadlines (not consistent).

Qualifications

• BS in Nursing, Pharmacist (BSPharm or PharmD), or off-shore Medical or Pharmacy degree (MBBS or higher).
• Other Bachelor’s degree (or equivalent work experience).
• Nationally recognized coding credential through AHIMA or AAPC (e.g., CCS, CPC) preferred and required.

Job Demands

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of assigned work.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Providing a dedicated, secure work area with high-speed internet access and office setup.

Pay

Base compensation ranges from $95,000 to $115,000 per year. Specific offers are determined by factors such as experience, education, skills, certifications, and business needs.

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) per year, depending on level and length of service.