responsible for the research, quality assurance, and opportunity analysis associated with new medical policies
review and analysis of current medical policies
assisting in the research necessary to define additional logic and algorithms to expand the Cotiviti payment policy library
work on pharmacy claims editing policies
ability to analyze complex data and synthesize it for customer and internal consumption
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
writing business logic for new rules and enhancements by translating industry references into Cotiviti policy
input on any new, or complex enhancements to the rule engine developers as well as system architects
ensure internal Cotiviti operational teams have a clear vision and understanding of the content solutions roadmap

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

medical, dental, vision, disability, and 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

Content Solutions Analyst II

Key skills