Content Analyst II (Medicaid)

Overview:

The Content Analyst II 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.  Specific focus for this role will be on our Medicaid team. 

• 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.

• One of the following degrees is required:
  • 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).
• Knowledge of Medicaid guidelines highly preferred. 
• 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.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• 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.
• No adverse environmental conditions are expected.
• After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent).

Base compensation ranges from $68,000 to $95,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. 

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 1/29/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 3/29/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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