Content Solutions Analyst I

Overview The Content Solutions Analyst I 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. The Content Solutions team works within Payment Policy Management and supports all of our PPM Solutions: outpatient, inpatient, pharmacy, fraud, and dental. There is no expectation, if hired, that you will align with only one solution and you should be prepared to work in all of our solutions. 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 policy 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. - This position requires maximum guidance from mentors and leadership. - Perform multi-faceted analytics for data and report analysis with minimal direction. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change. Qualifications Education & Certification: - BS in Nursing. - Pharmacist (BSPharm or PharmD). - Off-shore Medical or Pharmacy degree (MBBS or higher). - Other Bachelors degree (or equivalent work experience). AND - RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, CPhT OR willingness to obtain certification within one year of employment. Experience: - 3 years in clinical/retail setting as nurse, pharmacist, or physician, OR 3 years clinical coding in payer setting. - An additional 3 years research experience related to coding (CPT, HCPCS, ICD, NDC) OR at least 3 years in an internal Cotiviti role (CPM, CSM, Content Analyst, etc.). - 5 years previous experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements required. - Experience supporting Behavioral Health and/or Laboratory payment integrity rule development, including coding research and rule logic application, is preferred. - Strong analytical, critical thinking and problem-solving skills. - Proficiency in Microsoft Office Suite. - Excellent interpersonal, verbal and written communication skills. Job Demands: - Must have flexibility and willingness to participate in the work processes of an international organization. - After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent). Mental Requirements: - Communicating with others to exchange information. - Assessing the accuracy, neatness, and thoroughness of the work assigned. Physical Requirements and Working Conditio