Clinical Consultant I

🕒 Agosto 23

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $80.000 - $95.000 / ano

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

💼 Consultor

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

👻 Score fantasma 32%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

Cotiviti é uma empresa de tecnologia e análise em saúde que se especializa em melhorar a precisão e o desempenho dos pagamentos por meio de soluções avançadas de análise de dados. Eles se associam a planos de saúde, agências governamentais e provedores de serviços de saúde para fornecer insights que aprimoram a qualidade e a eficiência na prestação de cuidados. Com soluções como ajuste de risco, gerenciamento de políticas de pagamento e engajamento de membros, a Cotiviti busca otimizar os resultados financeiros e clínicos para o ecossistema de saúde.

Descrição

• Support Clinical Services teams in validating quality and process consistency on the CPE editing engine • Provide Coding Validation subject matter expertise to clients and internal stakeholders throughout planning, implementation, go-live, transition to operations, and contract duration • Act as liaison for clinical information between internal partners and external customers • Facilitate client understanding of Coding Validation policies and concepts • Respond to client inquiries in compliance with policies and procedures • Review and analyze Coding Validation client inquiries and Change Requests • Assess impacts of decisions on affected policies and communicate with clients to clarify information • Provide resources for provider abrasion issues and Coding Validation quality issues • Explain Coding Validation coding concepts in writing and verbally • Communicate quality review results and revisions to clients • Develop action plans with the Quality Team to mitigate future issues • Collaborate with Client Teams to develop and maintain client relationships • Provide client-based input on edit configuration changes, rule updates, and new editing development • Assist Clinical Content Teams with client-perspective feedback on trends and new rules • Work with Quality, Training, and Operations Teams on review guideline updates, client-specific review changes, and client issues • Support Coding Validation implementations, including reviewing test claims and internal go-live support • Act as support liaison for the appeals management process • Support CPE Clinical Services quality assurance, including pre- and post-release testing • Assist with validation and review of client payment policies • Maintain Client Information Workbooks • Provide support during user acceptance testing in Nucleus

🎯 Requisitos

• Associate or Bachelor’s degree in Nursing • Active and unrestricted Registered Nursing license (RN) in state of residence • Professional coder certification (CPC, CPC-H, CPC-P, or CCS-P), RHIT, or RHIA certification required • 2+ years of clinical experience as a Registered Nurse • 1+ years of experience in Coding Validation • 1+ years of experience in coding including professional and outpatient facilities • 1+ years of experience in claims adjudication, medical/payment policy, or utilization review working for a managed care or healthcare insurance company, or related experience • 1+ years of experience in customer service or client management with a strong focus on healthcare setting • Ability to analyze complex data and synthesize it for customer and internal consumption • Strong research capabilities and knowledge of CMS guidelines, regulatory compliance guidelines and mandates, and medical payment policy • Proficient with Microsoft Office Suite (Word, Excel, PowerPoint) • Working knowledge of Cotiviti systems preferred • Demonstrates basic working knowledge of Nucleus, JIRA, Mantis, MicroStrategy, and Tableau within 90 days of hire • Knowledge of medical terminology • Effective analytic and problem-solving skills • Ability to handle multiple tasks, prioritize, and meet deadlines • Ability to properly handle confidential information • Ability to work independently and collaboratively in a fast-paced environment • Strong written and verbal communication and interpersonal skills • Ability to work with remote cross-functional product teams • Computer and technology literacy • Flexibility to participate in an international organization’s work processes and global-time-zone conference calls • After-hours and/or weekend work may be required for major deliverables/deadlines • Travel requirement up to 10% • Ability to provide a dedicated, secure work area • Ability to provide high-speed internet access/connectivity and office setup and maintenance • Ability to sit and use a computer keyboard for extended periods • Must be located in the continental US

🏖️ Benefícios

• 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) per year, depending on level and length of service • Remote work arrangement • Dedicated, secure work area and high-speed internet/office setup provided by the worker

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