Clinical Analyst
Cotiviti India
Pune, Maharashtra
JOB 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 logics and record reviews
Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations.
Contribute to PCI product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency.
Reports his/her work performance on a timely basis to the team lead
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

ATTRIBUTES AND BEHAVIORS

Develops and maintains positive working relationships with others
Shares ideas and information Ability to collaborate efficiently.
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.

Exhibits behaviors consistent with Cotiviti Values:
Integrity
Passionate Client Service
Teamwork
Accountability
Performance Excellence
Continuous Improvement

RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS

Medical degree (MBBS or BAMS or BHMS or BDS or B.P.Th) with CPC certification(Mandatory)
Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred.
Possesses knowledge of healthcare claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-9, CPT & HCPCS, etc.
Practical clinical experience working in a hospital/office or nursing home strongly preferred.
Has general knowledge of medical procedures, conditions, illnesses and treatment practices
Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency
Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.

SKILLS & COMPETENCIES

Strong analytical, critical thinking and problem-solving skills
Excellent verbal and written communication skills
Be a quick learner and proficient in application of learnings
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