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Über
Responsibilities
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
Provide coding, claims processing and industry expertise to help create clinical coding 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
Perform multi-faceted analytics for data and report analysis with minimal direction
Mentor and train new staff
Provide input to peers as well as QA on peer work
This position requires intermediate guidance from mentors and leadership
Education & Certification
Pharmacist (BSPharm or PharmD)
Off‑shore Medical or Pharmacy degree (MBBS or higher)
RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, CPhT OR willingness to obtain certification within one year of employment
Experience
3 years in clinical, retail or working for a payer as a pharmacist or physician
An additional 5 years research related to coding (CPT, HCPCS, ICD, NDC) OR a minimum of 5 years in an internal Cotiviti role (CPM, CSM, Content Analyst, etc) required
5 years previous experience in detailed rule requirement gathering, rule development, and collaborating on software enhancements required
Strong analytical, critical thinking and problem‑solving skills
Proficiency in Microsoft Office Suite
Excellent interpersonal, verbal and written communication skills
Job Demands
Must have flexibility and willingness to participate in the work processes of an international organization
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.
No adverse environmental conditions expected.
Base compensation ranges from $110,000 to $130,000. 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.
Equal Employment Opportunity Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes individuals based on their qualifications for a specific job. Selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy or pregnancy‑related conditions, national origin, sexual orientation, gender identity, marital status, genetic carrier status, military service, veteran status, uniformed service member status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.
Pay Transparency Nondiscrimination Provision Cotiviti will not discharge or in any 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 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-I.35(c)
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Sprachkenntnisse
- English
Hinweis für Nutzer
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