Content Analyst II - Drug and Biological Policy

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.