Content Analyst II – Drug and Biological Policy

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $100k - $135k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

✍️ Content Marketing Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Provide coding and industry expertise to help create and maintain clinical coding edits. • Responsible for writing business logic for new rules and enhancements by translating industry references into Cotiviti policy. • Reviews and identifies changes to D&B policies in order to maintain an accurate and current medical policy library. • Work with the client teams to provide coding and clinical expertise for customer inquiries, questions, challenges or appeals of clinical rules. • Assumes full ownership and accountability for assigned D&B policies. • Help mentor and train any new team members. • Assist other team members when there are questions regarding policy reviews, logic revisions and research requests performed by others to ensure accuracy. • Maintains current knowledge of industry and Cotiviti content, best practices, applications, procedures and policies. • 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 Pharmacist (BSPharm or PharmD) • Professional certification (AHIMA or AAPC) preferred or willingness to pass certification exam within one year of employment • 5+ years of experience as a pharmacist with at least three years of experience in a specialty, clinical, or bedside setting. • At least three years’ experience in medical policy or prior authorization in a health plan setting preferred • Experience in internet-based research as it relates to drug information and coding (CPT, HCPCS, ICD, or NDC) • Familiarity with claims payment and reimbursement methodologies • Ability to analyze data and synthesize it for internal consumption • Ability to work well both independently and collaboratively • Effective at managing timelines and multiple projects with high accuracy and attention to detail • Strong analytical, critical thinking, and problem-solving skills • Proficiency in Microsoft Office suite. Preferred knowledge of Excel, Pivot table, functions to analyze data • Excellent interpersonal, verbal and written communication skills

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance • 401(K) savings plans • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year