Content Analyst III (Remote) (Nursing or HIM Professional)

Cotiviti, Inc. - Remote

Full-time
Primary Responsibilities

Conduct thorough research and analysis to develop unique medical policy content
Constantly surveys industry references for sources of new policy
Stays up to date on changes in the US healthcare system that could impact Cotiviti business
Communicates with the medical policy owners to ensure there is no overlap in policy creation
Works closely with the product team and developers to enhance system architecture to support novel policy creation
Performs multi-faceted data analytics for policy creation and monitoring of department goals
Analyze research inquiries from a multitude of sources and apply solid judgment to determine potential impact to medical policies
Perform QA of policy reviews, logic revisions, and research requests performed by other analysts to ensure accuracy.
Other Related Responsibilities

Other duties as assigned

REQUIREMENTS:
Possess in-depth knowledge of medical billing, claims, claims adjudication, and correct coding
Thorough understanding and proficiency using Cotiviti applications such as the RMI, CVP, or RPE rules engines, Lotus notes, eLL, or Nucleus
Broad knowledge of Cotiviti medical policy content, especially Medicare and Commercial products
Results driven, deadline oriented, and ability to work with a sense of urgency
Adept with handling large data sets, with ability to manipulate data to aid research and problem solving
Responsive to learning new tools and analytical techniques
Capable of relating current system and operational responsibilities into new system and process design
Prior experience working with health plan clients including client claims editing policy and implementation is highly desirable
Experience working in the US healthcare system at the point of care is highly desirable
High attention to detail
Proficient with Microsoft Office Suite (Word, Excel, Power Point); Intermediate Excel
Professional with ability to properly handle confidential information
Ability to work well independently and in a team environment
Ability to handle multiple tasks, prioritize and meet deadlines
Ability to work within a matrix organization
Excellent written and verbal communication skills with the ability to present new policy concepts to a wide range of stakeholders
Communicates with ease up and down the chain of leadership
Exhibits behaviors consistent with Cotiviti Values.

MINIMUM QUALIFICATIONS:
Bachelors Degree (or higher) preferred (or equivalent experience)
Minimum of 3 years of experience in developing medical payment policy edits
Minimum of 3 years of medical policy experience
Minimum of 2 years of experience working in either the RMI, CVP or RPE rules engines
Professional HIM certification (RHIA, RHIT, CPC, CPC-H, CPC-P or CCS-P), LPN, or RN with medical coding knowledge
Knowledge of Cotiviti Medical Policies
Claims analysis / claim opportunity analysis required

JOB DEMANDS:
Must be able to sit and use a computer keyboard for extended periods of time
Must be able to lift up to 20 lbs without assistance
Some limited travel required
Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)