Job Description:

Description

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 to this role we'll be focused on drug & biologic research and will ideally look for someone with a clinical oncology background.

Responsibilities:

- Provide coding and industry expertise to help create and maintain clinical coding edits focused on Drugs and Biological policies (D&B)

- Responsible for writing D&B 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 of 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

Requirements

- One of the following degrees is required:

- Active professional license as a Registered Nurse (BSN preferred),

- Pharmacist (BSPharm or PharmD)

- Offshore Medical Degrees (MBBS or higher)

- Professional certification (RHIA, RHIT, CPC, CPC-H, CPC-P or CCS-P) preferred or willingness 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

- Experience working with or administering complex drugs: oncology, rheumatology, etc. and knows how to read reference material and understand off label usage.

- Strong understanding of drug labels, on-line drug reference material and clinical phases

- Minimum of 3 years of experience in internet-based research as it relates to codes (CPT, HCPCS, ICD or NDC)

- 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.

Job Demands

- This is a work at home position. Access to high speed internet is required (all other equipment will be provided).

- Availability to travel in to Atlanta initially associated with training (combined with virtual training)

- 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)

- For the safety of our employees and those considering employment with Cotiviti, we are currently conducting all interviews virtually. In addition, the majority of the Cotiviti team is currently working remotely, and we are onboarding new hires remotely as well. As we monitor the pandemic, these arrangements may change and we will update accordingly.

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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).

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