As a Concept Development Analyst, you will lead the identification, creation, and implementation of innovative solutions in the healthcare billing and coding field. Collaborating with a technical engineer, you will contribute to the development of data-driven queries aligned with billing policies and regulatory guidelines, such as those outlined in the CMS Medicare Claims Processing Manual.
This role involves analyzing healthcare billing rules, translating them into actionable queries, and supporting audit and recovery initiatives. You will take ownership of each query, seeing it through the entire workstream—from initial concept development and data analysis to implementation, monitoring, and refinement based on updated bill rules and regulations.
Leveraging your expertise in Medicare regulations, provider billing practices, and data analysis, you will assist in creating novel strategies to enhance claim selection processes, particularly in data mining and automated reviews. Your knowledge of the Medicare Claims Processing Manual, prospective payment systems, provider fee schedules, and coding guidelines will be critical in optimizing proprietary tools to ensure the highest level of payment integrity for our clients.
Strong organizational skills, a deep understanding of payment policies, and proficiency in data analysis will drive the success of this role. Working closely with senior team members, you will refine and implement advanced approaches to improve claim selection methodologies. Additional responsibilities include monitoring query outputs, evaluating audit performance outcomes, and investigating discrepancies or variances.
This role is dedicated to serving government payers and plays a vital part in supporting program integrity and compliance while ensuring the success of queries throughout their lifecycle.
Mental Requirements:
Physical Requirements and Working Conditions:
Base compensation ranges from $95,000 to $120,000 per year. 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.
Date of posting: 01/06/2025
Applications are assessed on a rolling basis. We anticipate that the application window will close on 03/06/2025, 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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