Content Analyst II – Drug and Biological Policy
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Job Description
Pharmacist analyzing drug policies and coding edits for Cotiviti’s healthcare payment solutions. Researching clinical rules, maintaining policy libraries, and supporting healthcare clients.
Responsibilities:
- Research, quality assure, and maintain existing Drug and Biological policies
- Define additional logic and algorithms to expand the D&B Library and add value for clients
- Provide coding and industry expertise to create and maintain clinical coding edits
- Write business logic for new rules and enhancements by translating industry references into Cotiviti policy
- Review and identify changes to maintain an accurate and current medical policy library
- Work with client teams on coding and clinical questions, challenges, inquiries, and appeals of clinical rules
- Own and remain accountable for assigned D&B policies
- Mentor and train new team members
- Assist team members with policy reviews, logic revisions, and research requests to ensure accuracy
- Maintain current knowledge of industry and Cotiviti content, best practices, applications, procedures, and policies
- Complete special projects and other assigned duties
- Participate in international-organization processes, including global-time-zone conference calls
- Ensure confidentiality and security of data
Requirements:
- Active professional license as a Pharmacist (BSPharm or PharmD)
- 5+ years of experience as a pharmacist
- At least 3 years of experience in a specialty, clinical, or bedside setting
- At least 3 years of experience in medical policy or prior authorization in a health plan setting preferred
- Experience with internet-based research related to drug information and coding (CPT, HCPCS, ICD, or NDC)
- Familiarity with claims payment and reimbursement methodologies
- Ability to analyze and synthesize data for internal consumption
- Ability to manage timelines and multiple projects with high accuracy and attention to detail
- Strong analytical, critical thinking, and problem-solving skills
- Proficiency in Microsoft Office Suite
- Preferred knowledge of Excel, PivotTable, and functions for data analysis
- Excellent interpersonal, verbal, and written communication skills
- Professional certification (AHIMA or AAPC) preferred, or willingness to pass the certification exam within one year of employment
- Access to high-speed internet
- Flexibility to participate in international organization work processes and global-time-zone conference calls
- Must be able to perform duties with or without reasonable accommodation
- Must be able to provide a dedicated, secure work area
- Must be able to provide high-speed internet access/connectivity and office setup and maintenance
- Must be able to sit and use a computer keyboard for extended periods
- Must be able to remain stationary, often standing or sitting for prolonged periods
- Must be able to perform repetitive wrist, hand, and/or finger motions
- Commitment to Cotiviti values, information security, compliance, confidentiality, and data security
Benefits:
- 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
- All other equipment will be provided
- Equal employment opportunity employer
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