Clinical Policy & Coding Content Analyst I

Visa Hunt; United States; On-site; USD 95,000 - 115,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Disability Insurance

Life Insurance

401(k)

Paid Family Leave

Holidays

PTO

Job summary

Cotiviti is hiring a Content Solutions Analyst I to join the clinical operations and content team, focusing on research, quality assurance, and policy logic for Cotiviti’s payment policy library. The role supports multiple solutions including outpatient, inpatient, pharmacy, fraud, and dental.

You will work with Product, Go to Market, and development teams to ensure accurate rule logic and policy rollout. Strong analytical and communication skills are essential.

Qualifications

• BS in Nursing; Pharmacist (BSPharm or PharmD); Off-shore Medical or Pharmacy degree (MBBS or higher); Other Bachelor’s degree.
• RHIA, RHIT, CPC, CPC-H, CCS-P, SAFe, CPhT OR willingness to obtain certification within one year of employment.
• 3 years in clinical/retail setting as nurse, pharmacist, or physician; OR 3 years clinical coding in payer setting.
• 5 years experience in detailed rule requirement gathering, rule development, and software enhancements.
• Experience supporting Behavioral Health and/or Laboratory payment integrity rule development preferred.
• Strong analytical, critical thinking and problem-solving skills.
• Proficiency in Microsoft Office Suite.
• Excellent interpersonal, verbal and written communication skills.

Responsibilities

• Familiarity with claims payment and reimbursement methodologies and medical policy rules.
• Analyze complex data and synthesize it for customer and internal use.
• Work independently and collaboratively in a fast-paced environment.
• Manage timelines and multiple projects with high accuracy.
• Provide coding, claims processing, and industry expertise to create clinical/policy rules.
• Write business logic for new rules and enhancements.
• Provide input to rule engine developers and system architects.
• Collaborate with Product and Go to Market teams for new policy rollout.
• Align content solutions roadmap with internal teams.
• Perform multi-faceted analytics for data and report analysis.

Skills

Analytical thinking

Communication

Policy development

Project management

Education

BS in Nursing

BSPharm or PharmD

MBBS or higher

Other Bachelor's degree

Tools

Microsoft Office Suite

Job description

Cotiviti is hiring a Content Solutions Analyst I to join the clinical operations and content team, focusing on research, quality assurance, and policy logic for Cotiviti’s payment policy library. The role supports multiple solutions including outpatient, inpatient, pharmacy, fraud, and dental.

You will work with Product, Go to Market, and development teams to ensure accurate rule logic and policy rollout. Strong analytical and communication skills are essential.