[Hiring] Clinical Analyst I @Cotiviti

Role Description

This Coding Validation Analyst I 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. This position requires strong organizational skills and the ability to meet strict key performance indicators in a fast-paced work environment. Daily, substantive contact with internal staff.

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

Responsibilities

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement and meet required client turnaround time and KPI goals.
• Respond to provider appeals and meet required client turnaround time and KPI goals.
• Contribute to product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency.
• Utilize Coding Validation specific training to become familiar with claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

Qualifications

• Active professional license as a Registered Nurse in your current state of residence (BSN preferred).
• 2 years of professional experience in providing direct patient care.
• Coding Certification Preferred (Outpatient - CPC, CCS or CCS-P) or required to obtain within 1st year of employment.
• Required to obtain NY Independent Insurance Adjuster licensure within the first four months.
• Strong working knowledge of medical procedures, conditions, illnesses, and treatment practices.
• Excellent personal computer skills in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
• This position may require after-hours, weekend, or holiday hours to accomplish client objectives.
• 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 April 13, 2026; 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, including rotating weekends and holidays.

Requirements

• Ability to absorb new information quickly and train in a fast-paced environment.
• Ability to work in a high-pressure production environment and make audit decisions efficiently and accurately.
• 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.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area that is free from distractions, to allow and maintain high levels of productivity.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Benefits

• Base compensation ranges from $34.00 to $38.00 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.
• Non-Exempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week.
• Cotiviti offers a competitive benefits package 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.