Content Solutions Analyst I (Certified Lab Coder)

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, genetics, pharmacy, fraud, and dental.

This role is intended to work within our Genetics/Lab Content Team and we are looking for an experienced certified lab coder to support medical policy & edit development. 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