Clinical Consultant I

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $80k - $95k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

🦅 H1B Visa Sponsor

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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

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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