Remote Content Policy & Coding Analyst I

Cotiviti; Idaho; Remote; USD 96,000 - 116,000; Full time

Job summary

Cotiviti is seeking a Content Solutions Analyst I to join the clinical operations and content team. You will research, QA, and analyze new medical policies and assist in expanding the policy library.

You’ll work across outpatient, inpatient, pharmacy, fraud, and dental solutions and support multiple projects in a fast-paced environment. The role emphasizes collaboration, data analysis, and translating industry references into policy logic, with senior guidance from mentors and leadership.

Qualifications

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

Skills

Data analysis

Clinical coding

Project management

Communication

Attention to detail

Education

BS in Nursing

BSPharm or PharmD

MBBS or higher

Other Bachelor’s degree

RHIA/RHIT/CPC/CPC-H/CCS-P/SAFe/CPhT

Tools

Microsoft Office

Job description

Cotiviti is seeking a Content Solutions Analyst I to join the clinical operations and content team. You will research, QA, and analyze new medical policies and assist in expanding the policy library.

You’ll work across outpatient, inpatient, pharmacy, fraud, and dental solutions and support multiple projects in a fast-paced environment. The role emphasizes collaboration, data analysis, and translating industry references into policy logic, with senior guidance from mentors and leadership.