Content Analyst II – Medicaid

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $75k - $103k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

✍️ Content Marketing Manager

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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 conduct opportunity analysis associated with new medical policies • Review and analyze current medical policies • Research and define additional logic and algorithms to expand the Cotiviti payment policy library, with a focus on Medicaid • Provide coding and industry expertise to create and maintain clinical coding edits • Write business logic for new rules and enhancements by translating industry references into Cotiviti policy • Identify changes to medical policies to maintain an accurate and current medical policy library • Work with client teams to provide coding and clinical expertise for customer and provider inquiries, questions, challenges, and appeals regarding clinical rules • Own and remain accountable for assigned medical policies • Perform multifaceted data and report analysis with minimal direction • Mentor and train new staff • Perform quality assurance of policy reviews, logic revisions, and research requests completed by others • Maintain current knowledge of industry and Cotiviti content, best practices, applications, procedures, and policies

🎯 Requirements

• One of the following degrees/credentials is required: Active professional license as a Registered Nurse; Pharmacist (BSPharm or PharmD); Bachelor’s degree in a healthcare-related field; Offshore Medical Degree (MBBS or higher) • Professional certification (RHIA, RHIT, CPC, CPC-H, CPC-P, or CCS-P) preferred or willingness to pass certification exam within one year of employment • Minimum of 5 years of experience in a clinical setting as a nurse, pharmacist, or physician, or minimum of 6 years of clinical coding experience, preferably in a payer setting • Minimum of 3 years of experience in internet-based research relating to CPT, HCPCS, ICD, or NDC codes • Knowledge of Medicaid guidelines highly preferred • Familiarity with claims payment and reimbursement methodologies, medical policy rules, and edits • Ability to analyze complex data and synthesize it for customer and internal consumption • Ability to work independently and collaboratively in a fast-paced, demanding environment • Ability to manage timelines and multiple projects with high accuracy and attention to detail • Strong analytical, critical thinking, and problem-solving skills • Proficiency in Microsoft Office suite • Excellent interpersonal, verbal, and written communication skills • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance • After-hours and/or weekend work required when necessary for major deliverables/deadlines

🏖️ Benefits

• Medical, dental, vision, disability, and 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 specific level and length of service • Dedicated, secure work area • High-speed internet access/connectivity and office setup and maintenance