Cotiviti logo
Cotiviti

Founded in 1979, Cotiviti provides analytics-driven payment and network solutions for the healthcare and retail industries, offering services that help payers,

Clinical Analyst I

Location

United States

Posted

4 days ago

Salary

$34 - $38 / hour

Seniority

Mid Level

Bachelor Degree2 yrs expEnglish

Job Description

Clinical Analyst I

Cotiviti

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement and meet required client turnaround time and KPI goals • Respond to provider appeals and meet required client turnaround time and KPI goals • Contribute to product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency • Become familiar with claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc. • Complete all responsibilities as outlined in the annual performance review and/or goal setting • Complete all special projects and other duties as assigned

Job Requirements

  • Active professional license as a Registered Nurse in your current state of residence (BSN preferred)
  • 2 years of professional experience in providing direct patient care
  • Coding Certification Preferred (Outpatient - CPC, CCS or CCS-P) or required to obtain within 1st year of employment
  • Required to obtain NY Independent Insurance Adjuster licensure within the first four months
  • Strong working knowledge of medical procedures, conditions, illnesses, and treatment practices
  • Has excellent personal computer skills in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

Benefits

  • Health insurance
  • 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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