Job details

Content Analyst III

Overview:

The Content Analyst III is a key member of the clinical operations and content team responsible for the research and opportunity analysis associated with the development of new policy concepts and system enhancements to support new policy editing. In addition, this position will be responsible for communicating with medical policy owners to coordinate maintenance of new policy concepts, and with the content team about system updates.

Responsibilities:

Conduct thorough research and analysis to develop unique medical policy content.
Constantly surveys industry references for sources of new policy.
Stays up to date on changes in the US healthcare system that could impact Cotiviti business.
Communicates with the medical policy owners to ensure there is no overlap in policy creation.
Works closely with the product team and developers to enhance system architecture to support novel policy creation.
Performs multi-faceted data analytics for policy creation and monitoring of department goals.
Analyze research inquiries from a multitude of sources and apply solid judgment to determine potential impact to medical policies.

Perform QA of policy reviews, logic revisions, and research requests performed by other analysts to ensure accuracy.
Complete all responsibilities as outlined on annual Performance Plan.

Complete all special projects and other duties as assigned.
Must be able to perform duties with or without reasonable accommodation.

Qualifications:

One of the following degrees is required:

Active professional license as a Registered Nurse (BSN preferred),
Pharmacist (BSPharm or PharmD)
Bachelor’s degree (healthcare-related field preferred)
Offshore Medical Degrees (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 clinical coding experience, preferably in a payer setting.
Minimum of 3 years of experience in developing medical payment policy edits.
Minimum of 3 years of medical policy experience.
Claims analysis/claim opportunity analysis required.
Possess in-depth knowledge of medical billing, claims, claims adjudication, and correct coding.
Thorough understanding and proficiency using Cotiviti applications.
Broad knowledge of Cotiviti medical policy content, especially Medicare and Commercial products.
Results driven, deadline-oriented, and ability to work with a sense of urgency.
Adept with handling large data sets, with ability to manipulate data to aid research and problem solving.
Responsive to learning new tools and analytical techniques.
Capable of relating current system and operational responsibilities into new system and process design.
Prior experience working with health plan clients including client claims editing policy and implementation is highly desirable.
Experience working in the US healthcare system at the point of care is highly desirable
High attention to detail.
Proficient with Microsoft Office Suite (Word, Excel, PowerPoint); Intermediate Excel.
Professional with ability to properly handle confidential information.
Ability to work well independently and in a team environment.
Ability to handle multiple tasks, prioritize and meet deadlines.
Ability to work within a matrix organization.
Excellent written and verbal communication skills with the ability to present new policy concepts to a wide range of stakeholders.
Communicates with ease up and down the chain of leadership
Exhibits behaviors consistent with Cotiviti Values.

Job Demands

This is a work-at-home position. Access to high-speed internet is required (all other equipment will be provided).
Must be able to sit and use a computer keyboard for extended periods of time
Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent)

Base compensation ranges from $88,000 to $112,500. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

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CEO of Cotiviti

Emad Rizk, M.D.

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By Cotiviti

Cotiviti, a premier analytics and solutions firm, harnesses vast clinical and financial data to offer insights that enhance the efficiency, quality, and financial health of the healthcare system.

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