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
Reviews and identifies changes to medical policies in order to maintain an accurate and current medical policy library
Work with the client teams to provide coding and clinical expertise for customer and provider inquiries, questions, challenges, or appeals to clinical rules
Assumes full ownership and accountability for assigned medical policies
Performs multi-faceted analytics for data and report analysis with minimal direction
Mentor and train new staff
Performs QA of policy reviews, logic revisions, and research requests performed by others to ensure accuracy
Maintains current knowledge-base of industry and Cotiviti content, best practices, applications, procedures, and policies

Active professional license as a Registered Nurse (BSN preferred), Pharmacist (BSPharm or PharmD), Bachelor’s degree (healthcare-related field preferred), Offshore Medical Degrees (MBBS or higher)
Professional certification (RHIA, RHIT, CPC, CPC-H, CPC-P, or CCS-P) preferred or willing to pass certification exam within one year of employment
Minimum of 5 years of experience in a clinical setting as a nurse, pharmacist, or physician OR minimum of 6 years of clinical coding experience, preferably in a payer setting
Minimum of 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
Effective at managing timelines and multiple projects with high accuracy and attention to detail
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

Content Analyst II

Key skills