Clinical Analyst I

Cotiviti

23h•Remote

About The Position

This Coding Validation Analyst I position will perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical knowledge and background to ensure appropriateness for reimbursement and will also respond to provider appeals. This position requires strong organizational skills and the ability to meet strict key performance indicators in a fast-paced work environment. Daily, substantive contact with internal staff. This is a closely monitored productivity-driven role and can be done anywhere in the continental US. This is shift work and hours need to be flexible as the team runs 24 x 7. Shifts include (after training): First, second and third shifts (in Mountain Time) with rotating weekends and holidays.

Requirements

Active professional license as a Registered Nurse in your current state of residence.
2 years of professional experience in providing direct patient care.
Required to obtain NY Independent Insurance Adjuster licensure within the first four months.
Strong working knowledge of medical procedures, conditions, illnesses, and treatment practices.
Has excellent personal computer skills in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
Ability to absorb new information quickly and train in a fast-paced environment and ability to learn, test and pass off new training concepts daily.
Ability to work in a high-pressure production environment and make audit decisions efficiently and accurately.
Possesses excellent written and verbal communication skills.
Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency.
Assessing the accuracy, neatness and thoroughness of the work assigned.
Must be able to provide a dedicated, secure work area that is free from distractions, to allow and maintain high levels of productivity.
Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Nice To Haves

BSN preferred
Coding Certification Preferred (Outpatient - CPC, CCS or CCS-P) or required to obtain within 1st year of employment.

Responsibilities

Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement and meet required client turnaround time and KPI goals.
Respond to provider appeals and meet required client turnaround time and KPI goals.
Contribute to product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency.
Utilize Coding Validation specific training to Become familiar with claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc.
Complete all responsibilities as outlined in the annual performance review and/or goal setting.
Complete all special projects and other duties as assigned.
Must be able to perform duties with or without reasonable accommodation.

Benefits

medical
dental
vision
disability
life insurance coverage
401(K) savings plans
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 with Cotiviti
discretionary bonus consideration
overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law