Content Solutions Analyst I (Certified Lab Coder)

Summary

Cotiviti is seeking a Content Solutions Analyst I to support its clinical operations and content team, with a focus on genetics and laboratory content. The role researches and analyzes medical policies, develops coding rules and business logic, supports payment policy solutions, and collaborates with developers, architects, product teams, and operational stakeholders.

Responsibilities

• Provide coding, claims processing and industry expertise to help create clinical coding policy or pharmacy claims editing policy
• Responsible for writing business logic for new rules and enhancements by translating industry references into Cotiviti policy
• Provide input on any new, or complex enhancements to the rule engine developers as well as system architects
• Work within the ART, specifically providing guidance and input to TPO’s/developers during grooming sessions
• Work with Product and the Go to Market teams, to provide coding and clinical expertise for new policy rollout
• Ensure internal Cotiviti operational teams have a clear vision and understanding of the content solutions roadmap to ensure lock step on incoming work
• This position requires maximum guidance from mentors and leadership
• Perform multi-faceted analytics for data and report analysis with minimal direction

Skills

• 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
• Other Bachelors degree (or equivalent work experience)
• Nationally recognized coding credential through AHIMA or AAPC - CCS, CPC, etc
• 5+ years in coding/billing experience for a large lab that performs genetic testing and other unrelated lab services
• Expert in all aspects of genetics and lab coding, and able to provide education/support to clinical professionals (Genetic Counselors & others)
• An additional 3 years research experience related to coding (CPT, HCPCS, ICD, NDC) OR at least 3 years in an internal Cotiviti role (CPM, CSM, Content Analyst, etc.)
• Strong analytical, critical thinking and problem-solving skills
• Proficiency in Microsoft Office Suite
• Excellent interpersonal, verbal and written communication skills
• 5 years previous experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements
• Experience supporting Laboratory payment integrity rule development, including coding research and rule logic application

Qualifications

Must Haves

• 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
• Other Bachelors degree (or equivalent work experience)
• Nationally recognized coding credential through AHIMA or AAPC - CCS, CPC, etc
• 5+ years in coding/billing experience for a large lab that performs genetic testing and other unrelated lab services
• Expert in all aspects of genetics and lab coding, and able to provide education/support to clinical professionals (Genetic Counselors & others)
• An additional 3 years research experience related to coding (CPT, HCPCS, ICD, NDC) OR at least 3 years in an internal Cotiviti role (CPM, CSM, Content Analyst, etc.)
• Strong analytical, critical thinking and problem-solving skills
• Proficiency in Microsoft Office Suite
• Excellent interpersonal, verbal and written communication skills

Nice to Haves

• 5 years previous experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements
• Experience supporting Laboratory payment integrity rule development, including coding research and rule logic application

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