Content Solutions Analyst I (FWA)

Cotiviti-posted 4 months ago
$95,000 - $115,000/Yr
Full-time • Senior
5,001-10,000 employees
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The Fraud, Waste & Abuse (FWA) Content Solutions Analyst is a key member of the clinical operations and content team responsible for the research, development, and quality assurance, associated with new FWA conditions. In addition, this position will be responsible for review and analysis of current conditions and assisting in the research necessary to ensure conditions stay current.

  • 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.
  • Understand data structures and warehousing, with the ability to create, use, and interpret complex database queries. Aggregate, filter, and tabulate results from large datasets.
  • Work with the client teams to provide coding and clinical expertise for customer and provider inquiries, questions, challenges or appeals of clinical rules.
  • Assumes full ownership and accountability for creation and accuracy rules.
  • Understand standard statistical metrics and how they are calculated. Be able to clearly explain these concepts to stakeholders.
  • Performs multi-faceted analytics for data and report analysis with minimal direction.
  • Understand aberrant billing behavior, clinical rationale, and standard elements of medical claims; translate logic into scripting language for execution.
  • Train and support internal teams on rule logic, parameters, and execution processes, with the ability to communicate technical details in concise, easily understandable terms to the appropriate audience.
  • Maintains current knowledge-base of industry and Cotiviti content, best practices, applications, procedures and policies.
  • Present information and ideas in a thoughtful and compelling manner; be clear and concise in verbal and written communications. Share information freely and speak openly and honestly. Seek to understand the perspectives of others.
  • Bachelor's degree with quantitative and/or programming focus (Analytics, Computer Science, Statistics, Mathematics, Economics, or Accounting) and 5 years of practical experience.
  • 3+ years of experience in internet-based research as it relates to codes (CPT, HCPCS, ICD or NDC).
  • Familiarity with claims payment and reimbursement methodologies as well as medical policy rules and edits.
  • Ability to analyze complex data and synthesize it for customer and internal consumption.
  • Ability to work well both independently and collaboratively, in a fast-paced and demanding environment.
  • Excellent interpersonal, verbal and written communication skills.
  • 2+ years of experience working with large datasets.
  • Hadoop experience preferred.
  • Experience analyzing and presenting data with strong spreadsheet and database query experience.
  • Advanced SQL skills required.
  • Hive, Spark, Scala skills preferred.
  • Experience with or ability to learn various applications, including Git, Oracle SQL Developer, Tableau, Cloudera Hadoop, and proprietary software.
  • Healthcare experience pertaining to medical claims processing is required.
  • Ability to learn and quickly absorb new material.
  • Strong analytical, quantitative, written, and interpersonal skills.
  • Experience working in an Agile delivery framework (SAFe® for Teams preferred).
  • Medical insurance
  • Dental insurance
  • Vision insurance
  • Disability insurance
  • 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
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