Content Solutions Analyst II
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Job Description
Content Solutions Analyst II responsible for pharmacy claims editing policies at Cotiviti. Conducting research, quality assurance, and opportunity analysis related to medical policies.
Responsibilities:
- 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
Requirements:
- 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
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 with Cotiviti
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