Job title: Clinical Content Analyst

Company: Cotiviti

Job description: Overview

JOB RESPONSIBILITIES

• Coordinates with US Research Medical Directors to manage the integrity of the Payment Policy Library and ensure the Payment Policy Library is accurate and up-to-date.
• Supports the scheduled review process for State Medicaid policies in collaboration with the US Client Medical Directors and/or Client Policy Managers.
• Responds to the research related queries pertaining to the medical policy raised by internal personnel or client including but not limited to:

i. Questions about claims edits that enforce medical policy.
ii. Interpretation of how claims edits relate to policy statements.
iii. Recommendations regarding modifications of edits.

• Supports quarterly and annual updates in collaboration with the US Research Medical Directors.
• Supports the scheduled review process for global and specialty policies in collaboration with the US Research Medical Directors.
• Works diligently to meet and exceed productivity and quality benchmarks
• Takes charge of ongoing learning and development and participates in relevant training and development activities
• Collaborates well with global research team members to advance the Research agenda.
• Supports other departments and client teams within Cotiviti on assigned project work.
• Supports other Research related activities as assigned

ATTRIBUTES AND BEHAVIORS

• Develops and maintains positive working relationships with others.
• Shares ideas and information.
• Assists colleagues unprompted.
• Takes pride in the achievement of team objectives.
• Has credibility with peers and senior managers.
• Self-motivated – driven to achieve results.
• Works with a sense of urgency.
• High customer service ethic – is passionate about meeting customer expectations and improving service levels.
• Keeps pace with change – acquires knowledge/skills as the business evolves.
• Handles confidential information with sensitivity.

RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS

• Medical degree (MBBS or BAMS or BHMS; Diploma in Specialties or MD preferred) OR Certified medical coder with a clinical background with minimum 2 years of experience in Coding.
• Clearance of all major exams (SSC, HSC, qualifying degree) in first attempt.
• Clearance of aptitude test for analytical, quantitative, and logical reasoning skills.
• Clearance of English assessment test for both written and verbal skills.
• Practical clinical experience working in a hospital/office or nursing home strongly preferred.
• Experience in US healthcare specifically billing, coding and health plan operations strongly preferred.
• Knowledge of ICD-10 coding preferred.

SKILLS & COMPETENCIES

• Strong analytical, critical thinking and problem solving skills.
• Excellent verbal and written communication skills.
• Excel proficiency.
• Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads.
• Ability to work well independently and maintain focus on a topic for prolonged periods of time.
• Comfort in working with team members that are remote and located in the US, India or other geographies.
• Ability to work within a matrix organization.

JOB DEMANDS

• Ability to work seated at a computer for long periods of time.
• Candidate should be ready to work in different shifts, including night shift.

KEY CONSTITUENTS

• No direct reports.
• Works with all Cotiviti business teams but especially Research (Medical Directors & Research Analysts), Medical Policy and Client Services.

Expected salary:

Location: Pune, Maharashtra

Job date: Sun, 25 Sep 2022 07:06:29 GMT

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