Clinical Analyst I

Overview

This clinical analyst position will perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical knowledge and background to ensure appropriateness for reimbursement and will also respond to provider appeals. Daily, substantive contact with internal staff. The formal title for this role is Coding Validation Analyst I but is staffed with RN's.

This is a closely monitored productivity-driven role and can be done anywhere in the continental US (this is shift work and hours need to be flexible...this team runs 24 x 7). Shifts include (after training): First, second and third shifts (in Mountain Time) with rotating weekends and holidays.

Responsibilities

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement.
• Respond to provider appeals.
• Respond to client logic and record reviews.
• 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.
• Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Qualifications

• 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.
• Willingness to obtain NY Independent Insurance Adjuster licensure.
• Strong working knowledge of medical procedures, conditions, illnesses and treatment practices..
• Has excellent personal computer skills in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
• This position may require after-hours, weekend, or holiday hours to accomplish client objectives. This is an hourly position and employees will be compensated accordingly.
• Training for this position lasts approximately 17 weeks and can be completed remotely, time off during the training period would not be preferred.
• Targeted start date is February 3, 2025; hours during training are 7 AM - 3 PM MT (9 am-5 pm ET) Monday-Friday...after training you will need to be able to work a scheduled shift, that will vary. Shifts include (after training): first, second and third shifts MT with rotating weekends and holidays. Each employee should plan on working rotating weekends and holidays, and that may include early mornings, evenings, nights, weekends, and rotating holidays (everyone is required to be flexible). This group of new hires will have weekends included in their shifts.

Mental Requirements:

• Possesses excellent written and verbal communication skills.
• Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency.
• Assessing the accuracy, neatness and thoroughness of the work assigned

Physical Requirements and Working Conditions:

• This position may require after hours, weekend or holiday hours to accomplish client objectives. This is an hourly position, and employees will be compensated accordingly.
• Training for this position lasts 17 weeks and can be completed remotely, time off during the training period would not be preferred.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands and/or fingers.
• No adverse environmental conditions expected.
• 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.

Base compensation ranges from $29.00 to $35.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

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, and 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 at Healthcare Analytics Careers | Cotiviti.

Date of posting: 11/18/2024

Applications are assessed on a rolling basis. We anticipate that the application window will close on 1/3/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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