Overview:
The Drug and Biological Policy (D&B) Content Analyst II is a key member of the clinical operations and content team and is responsible for the research, quality assurance, and maintenance of existing D&B policies. This individual is expected to define additional logic and algorithms to expand the D&B Library and add value for our clients who implement this policy.
Responsibilities:
- 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 D&B 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 inquiries, questions, challenges or appeals of clinical rules.
- Assumes full ownership and accountability for assigned D&B policies.
- Help mentor and train any new team members.
- Assist other team members when there are questions regarding policy reviews, logic revisions and research requests performed by others to ensure accuracy.
- Maintains current knowledge of industry and Cotiviti content, best practices, applications, procedures and policies.
- Complete all responsibilities as outlined in the annual performance review and/or goal setting.
- Complete all special projects and other duties as assigned.
- Must be able to perform duties with or without reasonable accommodation.
This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.
Qualifications:
- Active professional license as a Pharmacist (BSPharm or PharmD)
- Professional certification (AHIMA or AAPC) preferred or willingness to pass certification exam within one year of employment
- 5+ years of experience as a pharmacist with at least three years of experience in a specialty, clinical, or bedside setting.
- At least three years’ experience in medical policy or prior authorization in a health plan setting preferred
- Experience in internet-based research as it relates to drug information and coding (CPT, HCPCS, ICD, or NDC)
- Familiarity with claims payment and reimbursement methodologies
- Ability to analyze data and synthesize it for internal consumption
- Ability to work well both independently and collaboratively
- 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. Preferred knowledge of Excel, Pivot table, functions to analyze data
- Excellent interpersonal, verbal and written communication skills
- This is a work at home position. Access to high-speed internet is required (all other equipment will be provided)
- Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones
- After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent)
- Behaves in a way that consistently demonstrates commitment to Cotiviti values
- Demonstrates an understanding of Cotiviti policies, procedures, and external regulatory requirements regarding information security and compliance. Assures confidentiality and security of all data
Job Demands:
- This is a work-at-home position. Access to high-speed internet is required (all other equipment will be provided).
- Must be able to sit and use a computer keyboard for extended periods of time.
- Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
- After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent).
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.
Base compensation ranges from $100,000 to $125,000 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: 6/17/2026
Applications are assessed on a rolling basis. We anticipate that the application window will close on 8/17/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
#LI-JB1
#LI-Remote
#senior
