Content Solutions Analyst II - RX

Cotiviti

10d • $110,000 - $130,000 • Remote

About The Position

The Content Solutions Analyst II (RX) is a key member of the clinical operations and content team responsible for the research, quality assurance, and opportunity analysis associated with new medical policies. In addition, this position will be responsible for review and analysis of current medical policies and assisting in the research necessary to define additional logic and algorithms to expand the Cotiviti payment policy library.
Specific to this role we are looking for a pharmacist to work on our pharmacy claims editing policies.

Requirements

• Pharmacist (BSPharm or PharmD)
• Off-shore Medical or Pharmacy degree (MBBS or higher)
• AND
• RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, CPhT OR willingness to obtain certification within one year of employment
• 3 years in clinical, retail or working for a payer as a pharmacist or physician
• An additional 5 years research related to coding (CPT, HCPCS, ICD, NDC) OR a minimum of 5 years in an internal Cotiviti role (CPM, CSM, Content Analyst, etc) required
• 5 years previous experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements required
• Strong analytical, critical thinking and problem-solving skills
• Proficiency in Microsoft Office Suite
• Excellent interpersonal, verbal and written communication skills

Responsibilities

• 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
• Effective at managing timelines and multiple projects with high accuracy and attention to detail
• Provide coding, claims processing and industry expertise to help create clinical coding or pharmacy claims editing policy
• Responsible for writing business logic for new rules and enhancements by translating industry references into Cotiviti policy
• Provide input on any new, or complex enhancements to the rule engine developers as well as system architects
• Work within the ART, specifically providing guidance and input to TPO’s/developers during grooming sessions
• Work with Product and the Go to Market teams, to provide coding and clinical expertise for new policy rollout
• Ensure internal Cotiviti operational teams have a clear vision and understanding of the content solutions roadmap to ensure lock step on incoming work
• Perform multi-faceted analytics for data and report analysis with minimal direction
• Mentor and train new staff
• Provide input to peers as well as QA on peer work
• This position requires intermediate guidance from mentors and leadership

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree
• Number of Employees: 1,001-5,000 employees