Content Solutions Analyst I (Certified Lab Coder)

COTIVITI, INC.; South Jordan (UT); Remote; USD 85,000 - 120,000; Full time

Job summary

Cotiviti, Inc. is seeking a Content Solutions Analyst I (Certified Lab Coder) to join the Genetics/Lab Content Team.

The role focuses on research, QA, and policy analysis for new medical policies, and expands the payment policy library across outpatient, inpatient, genetics, pharmacy, and more. You will review current policies, write business logic for new rules, and collaborate with product and engineering teams.

Qualifications

• Familiarity with claims payment and reimbursement methodologies.
• Ability to analyze complex data and synthesize for customers and internal use.
• Independent and collaborative work in fast-paced environments.
• Experience in coding/billing for large labs performing genetic testing.
• Nationally recognized coding credential required (AHIMA or AAPC).

Responsibilities

• Familiarity with claims payment and medical policy rules.
• Analyze complex data and present findings to customers and teams.
• Work independently and collaboratively in fast-paced settings.
• Manage timelines and multiple projects with high accuracy.
• Develop clinical coding and pharmacy claims policy logic.
• Translate industry references into Cotiviti policy logic.
• Provide input to rule engine developers and system architects.
• Collaborate with ART and Go-to-Market teams on policy rollouts.
• Ensure content solutions roadmap alignment across teams.
• Receive guidance from mentors and leaders.
• Perform multi-faceted data analytics with minimal direction.

Skills

Coding policy development

Data analysis

Stakeholder collaboration

Regulatory/compliance knowledge

Education

BS in Nursing

BSPharm or PharmD

MBBS or higher

Other Bachelor's degree or equivalent

AHIMA or AAPC credential (CCS/CPC)

Job description

Content Solutions Analyst I (Certified Lab Coder) Job Locations US-Remote ID 2026-20145 Category Clinical Position Type Full-Time

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. The Content Solutions team works within Payment Policy Management and supports all of our PPM Solutions: outpatient, inpatient, genetics, pharmacy, fraud, and dental. This role is intended to work within our Genetics/Lab Content Team and we are looking for an experienced certified lab coder to support medical policy and edit development. There is no expectation, if hired, that you will align with only one solution and you should be prepared to work in all of our solutions.

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

• **Specific to the Content Solutions Analyst role focused on Labs Education and Certification:
• BS in Nursing.
• Pharmacist (BSPharm or PharmD).
• Off-shore Medical or Pharmacy degree (MBBS or higher).
• Other Bachelors degree (or equivalent work experience) PREFERRED.
• AND * Nationally recognized coding credential through AHIMA or AAPC – CCS, CPC, etc. REQUIRED.

Experience

• 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 and others).
• An additi onal 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 preferred.

Equal Opportun ty Employer/Protected Veterans/Individuals with Disabilities