Content Solutions Analyst I

Cotiviti • Remote,

5d • $96,000 - $116,000 • Remote

About The Position

The Content Solutions Analyst I is part of Cotiviti’s clinical operations and content team. The role researches, quality-checks, and analyzes opportunities related to new medical policies; reviews and analyzes existing policies; and researches logic and algorithms to expand the Cotiviti payment policy library. The Content Solutions team supports outpatient, inpatient, pharmacy, fraud, and dental payment policy solutions, and the analyst may work across all of them.

The analyst applies coding, claims processing, reimbursement, and clinical or pharmacy expertise to develop policy content and business logic. The role works with rule-engine developers, system architects, product and go-to-market teams, and internal operational teams to support enhancements and policy rollouts. It requires substantial guidance from mentors and leadership, along with the ability to perform data and report analysis with minimal direction.

Requirements

• One of the listed education or experience pathways: BS in Nursing; BSPharm or PharmD; an offshore medical or pharmacy degree (MBBS or higher); or another bachelor's degree or equivalent work experience.
• RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, or CPhT certification, or willingness to obtain a certification within one year of employment.
• Three years of experience in a clinical or retail setting as a nurse, pharmacist, or physician, or three years of clinical coding experience in a payer setting.
• An additional three years of coding-related research experience (CPT, HCPCS, ICD, or NDC), or at least three years in an internal Cotiviti role such as CPM, CSM, or Content Analyst.
• Five years of experience in detailed rule requirement gathering, rule development, and collaboration on software enhancements.
• 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.
• Ability to provide a dedicated, secure work area, high-speed internet connectivity, and office setup and maintenance.

Nice To Haves

• Experience supporting Behavioral Health and/or Laboratory payment-integrity rule development, including coding research and application of rule logic.

Responsibilities

• Research, perform quality assurance, and analyze opportunities associated with new medical policies.
• Review and analyze existing medical policies and research logic and algorithms to expand the payment policy library.
• Apply knowledge of claims payment, reimbursement methodologies, medical policy rules, and edits.
• Analyze complex data and synthesize findings for customers and internal stakeholders.
• Provide coding, claims-processing, and industry expertise to develop clinical coding policies or pharmacy claims-editing policies.
• Write business logic for new rules and enhancements by translating industry references into Cotiviti policy.
• Provide input on new or complex enhancements to rule-engine developers and system architects.
• Work within the ART and provide guidance and input to TPOs and developers during grooming sessions.
• Work with Product and Go-to-Market teams to provide coding and clinical expertise for new policy rollouts.
• Ensure internal Cotiviti operational teams understand the content solutions roadmap and incoming work.
• Perform multifaceted data and report analysis with minimal direction.
• Manage timelines and multiple projects accurately and with attention to detail, working independently and collaboratively.

Benefits

• Medical, dental, vision, disability, and life insurance coverage.
• 401(k) savings plan.
• Paid family leave.
• Nine paid holidays per year.
• 17–27 days of paid time off per year, depending on level and length of service.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level