Content Solutions Analyst I, Certified Lab Coder

🕒 August 21

🇺🇸 United States – Remote

💵 $95k - $115k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Business Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 20%

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Research, perform quality assurance, and analyze opportunities associated with new medical policies • Review and analyze current medical policies • Research and define additional logic and algorithms to expand Cotiviti’s payment policy library • Support Payment Policy Management solutions across outpatient, inpatient, genetics, pharmacy, fraud, and dental • Provide coding, claims-processing, and industry expertise to create clinical coding or pharmacy claims-editing policies • Write business logic for new rules and enhancements by translating industry references into Cotiviti policy • Provide input on complex enhancements to rule-engine developers and system architects • Guide and advise TPOs/developers during ART grooming sessions • Collaborate with Product and Go-to-Market teams on new policy rollouts • Ensure internal operational teams understand the content-solutions roadmap and incoming work • Perform multifaceted data and report analysis with minimal direction

🎯 Requirements

• BS in Nursing; Pharmacist (BSPharm or PharmD); off-shore Medical or Pharmacy degree (MBBS or higher); or another bachelor’s degree (or equivalent work experience) • Nationally recognized coding credential through AHIMA or AAPC—CCS, CPC, etc. preferred and required • 5+ years of coding/billing experience for a large laboratory performing genetic testing and other unrelated laboratory services • Expert knowledge of genetics and laboratory coding • Ability to provide education and support to clinical professionals, including 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 • 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 when necessary for major deliverables or deadlines • Ability to provide a dedicated, secure work area • Ability to provide high-speed internet access/connectivity and office setup and maintenance

🏖️ 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 per year • 17–27 days of Paid Time Off (PTO) per year, depending on specific level and length of service • Remote work arrangement • Secure dedicated work area and high-speed internet/office setup required for remote work