Content Solutions Analyst II - RX

Job description

Overview The Content Solutions Analyst II (RX) is a key member of the clinical operations and content team responsible for the research, quality assurance, and opportunity analysis associated with new medical policies. In addition, this position will be responsible for review and analysis of current medical policies and assisting in the research necessary to define additional logic and algorithms to expand the Cotiviti payment policy library. Specific to this role we are looking for a pharmacist to work on our pharmacy claims editing policies. Responsibilities: - Familiarity with claims payment and reimbursement methodologies as well as medical policy rules and edits - Ability to analyze complex data and synthesize it for customer and internal consumption - Ability to work well both independently and collaboratively, in a fast-paced and demanding environment - Effective at managing timelines and multiple projects with high accuracy and attention to detail - Provide coding, claims processing and industry expertise to help create clinical coding or pharmacy claims editing policy - Responsible for writing business logic for new rules and enhancements by translating industry references...