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. 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): second and third shifts (in Mountain Time) with rotating weekends and holidays.

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement.
• Ability to perform daily tasks in a fast paced production environment and meet the minimum key performance indicator requirement.
• Utilize a Client centered approach when reviewing claims, appeals and record reviews with an emphasis on client quality.
• Team focused attitude and willingness to adapt workflow based on client need.
• Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations.
• 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.

• Active professional license as a Registered Nurse in your current state of residence.
• 2 years of professional experience in providing direct patient care.
• Coding Certification Preferred (Outpatient - CPC, CCS or CCS-P) CPC is preferred 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.
• Strong medical-surgical background with critical thinking skills.
• Coding background helpful but not required.
• Possesses excellent written and verbal communication skills.
• Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency.
• Leadership experience preferred
• Intermediate computer skill set level with a strong foundation and working knowledge of Microsoft Office Suite (Excel, PowerPoint, Outlook)
• This is a Full-time position working a minimum of 40 hours per week on company scheduled shifts.
• 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 September 30, 2024; 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 perferred.
• 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 enviornmental 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: 6/21/2024

Applications are assessed on a rolling basis. We anticipate that the application window will close on 9/5/2024, 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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