[Hiring] Clinical Consultant I @Cotiviti

Role Description

The Clinical Consultant supports Clinical Services teams in the validation of quality and processes consistency on the CPE editing engine. Provides support and subject matter expertise on Coding Validation (CV) to both clients and internal stakeholders during the planning, implementation, go-live, transition to operational team, and through the duration of the contract. Collaborates with internal teams to provide meaningful input on CV processes, improvements, and support to maximize value and service for clients.

• Client facing Coding Validation support:
• Act as a liaison for clinical information between internal partners and external customers.
• Provide resources to facilitate client understanding of Coding Validation policies and concepts.
• Respond to client inquiries in a timely manner in compliance with policy and procedures.
• Review and analyze CV related client inquiries and Change Requests for clarity of intent.
• Provide support and resources to clients for provider abrasion issues.
• Review and provide written and/or verbal explanation of CV coding concepts.
• Resource to client for CV related quality issues.
• Communicate quality review results and revisions to clients when they occur.
• Provide action plans to mitigate future issues as needed with Quality Team.
• Add Value to Internal Teams:
• Proactively offer benefit of CV knowledge and experience.
• Work collaboratively with Client Teams to develop and maintain excellent client relationships.
• Collaborate and provide input from a client-based perspective on changes in edit configuration.
• Assist the Clinical Content Team with feedback from a client perspective on new trends.
• Work with Quality, Training, and Operations Teams to facilitate updates in CV review guidelines.
• Support resource for the Clinical Services team on Coding Validation implementations.
• Act as a support liaison for appeals management process.
• Quality:
• Support CPE Clinical Services quality assurance processes including pre and post release testing.
• Assist the Clinical Content Teams with validation and review of client payment policies.
• Maintain Client Information Workbooks with updated information as needed.
• Provide support during user acceptance testing in Nucleus.

Qualifications

• Education (required):
• Associate or Bachelor’s degree in Nursing (active/unrestricted license).
• License & Certification:
• Registered Nursing license (RN) – active and unrestricted in state of residence.
• Professional coder certification (CPC, CPC-H, CPC-P, or CCS-P), RHIT or RHIA certification required.
• Experience:
• 2+ years of clinical experience as a Registered Nurse.
• 1+ years of experience in Coding Validation.
• 1+ years of experience in coding including professional and outpatient facilities.
• 1+ years of experience in claims adjudication, medical/payment policy, or utilization review.
• 1+ years of experience in customer service or client management in a healthcare setting.
• Skills and Other Requirements:
• Ability to analyze complex data and synthesize it for customer and internal consumption.
• Strong research capabilities and knowledge of CMS guidelines and regulatory compliance.
• Proficient with Microsoft Office Suite (Word, Excel, Power Point).
• Working knowledge of Cotiviti systems preferred.
• Demonstrates basic working knowledge of applications within 90 days of hire.
• Knowledge of medical terminology.
• Detail oriented.
• Ability to handle multiple tasks, prioritize and meet deadlines.
• Effective analytic and problem-solving skills.
• Professional with ability to handle confidential information.
• Ability to work well independently and in a collaborative team environment.
• Ability to work in a fast-paced environment.
• Strong written and verbal communication and interpersonal skills.
• Ability to work with remote cross-functional product teams.
• Computer and technology literate.
• Ability to positively handle/manage stress.
• Flexibility to participate in international work processes.
• After hours and/or weekend work may be required.
• Travel requirement up to 10%.

Benefits

• Base compensation ranges from $80,000 to $95,000 per year.
• Competitive benefits package including:
• Medical, dental, vision, disability, and life insurance coverage.
• 401(k) savings plans.
• Paid family leave.
• 9 paid holidays per year.
• 17-27 days of Paid Time Off (PTO) per year.