Cotiviti is hiring a Content Solutions Analyst I to join our Payment Policy Management team. In this role, you will apply your clinical expertise to research, analyze, and define the logic that powers our payment policy library. You'll be instrumental in ensuring our solutions are accurate, effective, and aligned with industry standards.

What You'll Do

Provide coding, claims processing, and industry expertise to help create clinical coding and pharmacy claims editing policies.
Write business logic by translating industry references into Cotiviti payment policy.
Offer input on new or complex rule enhancements to developers and system architects.
Collaborate within the ART framework, providing guidance during grooming sessions with TPOs and developers.
Partner with Product and Go-to-Market teams to support new policy rollout with your coding and clinical knowledge.
Ensure internal operational teams have a clear understanding of the content solutions roadmap.
Perform multi-faceted analytics for data and report analysis with minimal direction.
Manage timelines and multiple projects with high accuracy and attention to detail.

What We're Looking For

Bachelor's degree in Nursing, Pharmacy (BSPharm or PharmD), an off-shore medical degree (MBBS or higher), or another Bachelor's degree (or equivalent work experience).
RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, or CPhT certification, or willingness to obtain within one year of employment.
3 years in a clinical/retail setting as a nurse, pharmacist, or physician, OR 3 years of clinical coding in a payer setting.
An additional 3 years of research experience related to coding (CPT, HCPCS, ICD, NDC) OR at least 3 years in an internal Cotiviti role (CPM, CSM, Content Analyst, etc.).
5 years of experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements.
Familiarity with claims payment, reimbursement methodologies, and 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 environment.
Strong analytical, critical thinking, and problem-solving skills.
Proficiency in the Microsoft Office Suite.
Excellent interpersonal, verbal, and written communication skills.
Flexibility to participate in the work processes of an international organization.
Availability for occasional after-hours or weekend work for major deliverables.
Ability to provide a dedicated, secure home office with high-speed internet.

Nice to Have

Experience supporting Behavioral Health and/or Laboratory payment integrity rule development, including coding research and rule logic application.

Team & Environment

You will work within the Content Solutions team, part of Payment Policy Management (PPM). This team supports all Cotiviti PPM Solutions, including outpatient, inpatient, pharmacy, fraud, and dental.