Note: The job is a remote job and is open to candidates in USA. Cotiviti is a healthcare solutions company, and they are seeking a Drug and Biological Policy Content Analyst II. The role involves researching, assuring quality, and maintaining D&B policies, as well as providing coding expertise and support to client teams.
Responsibilities
- Provide coding and industry expertise to help create and maintain clinical coding edits
- Responsible for writing business logic for new rules and enhancements by translating industry references into Cotiviti policy
- Reviews and identifies changes to D&B policies in order to maintain an accurate and current medical policy library
- Work with the client teams to provide coding and clinical expertise for customer inquiries, questions, challenges or appeals of clinical rules
- Assumes full ownership and accountability for assigned D&B policies
- Help mentor and train any new team members
- Assist other team members when there are questions regarding policy reviews, logic revisions and research requests performed by others to ensure accuracy
- Maintains current knowledge of industry and Cotiviti content, best practices, applications, procedures and policies
- Complete all responsibilities as outlined in the annual performance review and/or goal setting
- Complete all special projects and other duties as assigned
Skills
- Active professional license as a Pharmacist (BSPharm or PharmD)
- 5+ years of experience as a pharmacist with at least three years of experience in a specialty, clinical, or bedside setting
- Experience in internet-based research as it relates to drug information and coding (CPT, HCPCS, ICD, or NDC)
- Familiarity with claims payment and reimbursement methodologies
- Ability to analyze data and synthesize it for internal consumption
- Ability to work well both independently and collaboratively
- Effective at managing timelines and multiple projects with high accuracy and attention to detail
- Strong analytical, critical thinking, and problem-solving skills
- Excellent interpersonal, verbal and written communication skills
- This is a work at home position. Access to high-speed internet is required (all other equipment will be provided)
- Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones
- After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent)
- Behaves in a way that consistently demonstrates commitment to Cotiviti values
- Demonstrates an understanding of Cotiviti policies, procedures, and external regulatory requirements regarding information security and compliance. Assures confidentiality and security of all data
- Professional certification (AHIMA or AAPC) preferred or willingness to pass certification exam within one year of employment
- At least three years' experience in medical policy or prior authorization in a health plan setting preferred
- Proficiency in Microsoft Office suite. Preferred knowledge of Excel, Pivot table, functions to analyze data
Benefits
- Medical, dental, vision, disability, and life insurance coverage
- 401(K) savings plans
- Paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti
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