Content Solutions Analyst I

Cotiviti; United States; Remote; USD 95,000 - 115,000; Full time

Job summary

A leading company seeks a Content Solutions Analyst I to join its clinical operations team. This role involves the research and analysis of medical policies, along with developing coding and claims editing policies. Candidates must possess strong analytical and critical thinking skills, and a background in nursing or pharmacy is desirable. A competitive salary and comprehensive benefits are provided, including paid time off and health insurance.

Benefits

Medical insurance

Dental insurance

Vision insurance

401(k) savings plans

Paid family leave

Paid Time Off (PTO)

Qualifications

• 3 years in clinical/retail setting as nurse, pharmacist, or physician required.
• 5 years in detailed rule requirement gathering and collaboration.
• Proficiency in coding (CPT, HCPCS, ICD) is necessary.

Responsibilities

• Analyze complex data to create business logic for new policies.
• Work collaboratively with operational teams on content solutions.
• Perform analytics for data and report analysis with minimal direction.

Skills

Analytical skills

Critical thinking

Communication skills

Problem-solving skills

Education

BS in Nursing

Pharmacist (BSPharm or PharmD)

Off-shore Medical or Pharmacy degree

Tools

Microsoft Office Suite

Job description

Overview

The Content Solutions Analyst I 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.

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 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.

Qualifications

Education & Certification:

• BS in Nursing.
• Pharmacist (BSPharm or PharmD).
• Off-shore Medical or Pharmacy degree (MBBS or higher).
• Other Bachelors degree (or equivalent work experience).

AND

• 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 setting as nurse, pharmacist, or physician, OR 3 years clinical coding in payer setting.
• 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.).
• 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 $95,000 to $115,000 per year. 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.

Date of posting: 05/29/2025Applications are assessed on a rolling basis. We anticipate that the application window will close on 07/29/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

#LI-remote

#LI-JB1

#senior