Content Solutions Analyst I

🔥 13 minutes ago

🇺🇸 United States – Remote

💵 $96k - $116k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Business Analyst

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This company has sponsored H1B visas in the past.

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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 new medical policies and perform quality assurance and opportunity analysis • Review and analyze current medical policies • Research and define logic and algorithms to expand Cotiviti’s payment policy library • Support outpatient, inpatient, pharmacy, fraud, and dental payment policy management solutions • Analyze complex data and synthesize findings for customers and internal teams • Provide coding, claims processing, and industry expertise for clinical coding and pharmacy claims editing policies • Write business logic for new rules and enhancements by translating industry references into Cotiviti policy • Provide input to rule engine developers and system architects on new or complex enhancements • Guide and advise TPOs/developers during ART grooming sessions • Collaborate with Product and Go to Market teams on new policy rollouts • Communicate the content solutions roadmap to internal Cotiviti operational teams • Perform multifaceted analytics for 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 other Bachelor’s degree (or equivalent work experience) • RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, or CPhT certification, or willingness to obtain certification within one year of employment • 3 years in a clinical/retail setting as a nurse, pharmacist, or physician, or 3 years of clinical coding in a payer setting • An additional 3 years of research experience related to coding (CPT, HCPCS, ICD, NDC), or at least 3 years in an internal Cotiviti role • 5 years of experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements • Experience supporting Behavioral Health and/or Laboratory payment integrity rule development is 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 • After-hours and/or weekend work when necessary for major deliverables/deadlines • Ability to provide a dedicated, secure work area • High-speed internet access/connectivity and office setup and maintenance • Ability to remain stationary, often standing or sitting for prolonged periods • Ability to perform repetitive motions involving wrists, hands, and/or fingers

🏖️ 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 specific level and length of service • Remote work arrangement • Dedicated secure work area and high-speed internet/office setup support required