Clinical Analyst I

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🇺🇸 United States – Remote

💵 $34 - $38 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

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

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement and meet required client turnaround time and KPI goals • Respond to provider appeals and meet required client turnaround time and KPI goals • Contribute to product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency • Become familiar with claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc. • Complete all responsibilities as outlined in the annual performance review and/or goal setting • Complete all special projects and other duties as assigned

🎯 Requirements

• Active professional license as a Registered Nurse in your current state of residence (BSN preferred) • 2 years of professional experience in providing direct patient care • Coding Certification Preferred (Outpatient - CPC, CCS or CCS-P) or required to obtain within 1st year of employment • Required to obtain NY Independent Insurance Adjuster licensure within the first four months • Strong working knowledge of medical procedures, conditions, illnesses, and treatment practices • Has excellent personal computer skills in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

🏖️ Benefits

• Health insurance • 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 with Cotiviti