PRINCIPLE PURPOSE OF JOB
We are currently seeking a Research Analyst to support a growing client base while combining their clinical and/or coding expertise with payment policy. The Research Lead is a key member of the internal Research team, as well a contributor to the client team, and works closely with the US Research Medical Directors and/or Client Medical Directors and Client Policy Managers on Medical Policy decisions. The Research Analyst is responsible for clinically interpreting and assessing payment policy and medical coding information/guidelines against our policy library to support maintenance of existing policy and development of new policy. The Research Analyst also assists in providing consultations regarding payment policy queries from the clients as well as from the internal team.
Supports US Research Medical Directors and/or US Client Medical Directors and Client Policy Managers to provide oversight for the accuracy and quality of research materials originated from Medical Policy and Client Services.
Supports the scheduled review process for global and specialty policies in collaboration with the US Research Medical Directors.
Supports the scheduled review process for State Medicaid policies in collaboration with the US Client Medical Directors and/or Client Policy Managers.
Coordinates with US Research Medical Directors to manage the integrity of the Payment Policy Library and ensure the Payment Policy Library is accurate and up-to-date.
Supports quarterly and annual updates in collaboration with the US Research Medical Directors.
Ensures changes to rule sets are accurate, complete and are finished in a timely manner including documentation of notable changes.
Responds to the research related queries pertaining to the medical policy raised by internal personnel or client including but not limited to:
Questions about claims edits that enforce medical policy.
Interpretation of how claims edits relate to policy statements.
Recommendations regarding modifications of edits.
Conducts research to explore potential opportunities to expand the current medical policy set.
Partners well with global research team members to advance the Research agenda.
Educates US Client Service MDs and Client Policy Managers (CPMs) on new changes and policy updates by actively participating in monthly meetings.
Supports other departments and client teams within Cotiviti.
ATTRIBUTES AND BEHAVIORS
Develops and maintains positive working relationships with others.
Shares ideas and information.
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.
RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS
Medical degree (MBBS or BAMS or BHMS; Diploma in Specialties or MD preferred) OR Certified medical coder with a clinical background (including the above degrees plus BDS, OT, PT, Nursing) with minimum 2 years’ experience in Coding.
Clearance of all major exams (SSC, HSC, qualifying degree) in first attempt.
Clearance of aptitude test for analytical, quantitative, and logical reasoning skills.
Clearance of English assessment test for both written and verbal skills.
Practical clinical experience working in a hospital/office or nursing home strongly preferred.
Experience in US healthcare specifically billing, coding and health plan operations strongly preferred.
Knowledge of ICD-10 coding preferred.