Enabling a high-quality and viable healthcare system
Content Analyst II - Drug and Biological Policy
Location
United States
Posted
18 hours ago
Salary
$100K - $125K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Content Analyst II - Drug and Biological Policy
Cotiviti
Role Description The Drug and Biological Policy (D&B) Content Analyst II is a key member of the clinical operations and content team and is responsible for the research, quality assurance, and maintenance of existing D&B policies. This individual is expected to define additional logic and algorithms to expand the D&B Library and add value for our clients who implement this policy. - 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. - Must be able to perform duties with or without reasonable accommodation. Qualifications - Active professional license as a Pharmacist (BSPharm or PharmD). - Professional certification (AHIMA or AAPC) preferred or willingness to pass certification exam within one year of employment. - 5+ years of experience as a pharmacist with at least three years of experience in a specialty, clinical, or bedside setting. - At least three years’ experience in medical policy or prior authorization in a health plan setting preferred. - 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. - Proficiency in Microsoft Office suite. Preferred knowledge of Excel, Pivot table, functions to analyze data. - 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. Requirements - This is a work-at-home position. Access to high-speed internet is required (all other equipment will be provided). - Must be able to sit and use a computer keyboard for extended periods of time. - 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). 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. Benefits - Base compensation ranges from $100,000 to $125,000 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. - 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.
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