US National – 100% Remote Work
Analyst I, Concept Development
L Cotiviti Auditor ANALY02274
Concept Development Analyst I (Clinical Chart Validation)
The Analyst I, Concept Development position within CCV is responsible for creating healthcare audit concept projects, monitoring the effectiveness of new and existing audit concepts, and updating concept policies based upon changes in clinical and coding developments, statutes and regulations, and client policies. The goal of the position is to identify high-quality recoverable audit concepts and place them into production for the benefit of Cotiviti and our clients. The Analyst will identify, develop, and assist in the implementation of new concepts based upon industry experience, coding and billing knowledge and regulatory research. Conducts and documents more complex audit projects with guidance from the CCV leadership and other team members.
Assists in the Generation and Development of New Audit Concepts
Utilizes healthcare and auditing experience to investigate, identify and define coding and/or billing issues, develop concept criteria, and concept logic. Communicates results with senior team members and managers effectively. Demonstrates the ability to expand concepts based on customer requirements with a strong focus on concept approval.
Monitoring updates in Legislation, Medicare Reimbursement Rules, Medicare / Commercial Policies, Clinical Policy and Healthcare Coding
Proficient with Medicare reimbursement methodologies, coding and billing guidelines and applicable industry-based standards. Demonstrates ability to monitor and update concept criteria and logic on a daily, weekly, and monthly basis to reflect any changes in legislation, rules, and policies. Understands the importance of monitoring and implementing these updates in a timely manner.
Develops New Tools and Processes
Collaborates with Analytics, audit teams, and senior concept development team members in developing new reports. Fosters and implements new ideas, approaches, and technological improvements to support and enhance audit production, communication and client satisfaction.
Directs ownership for Quality Control
Assists with ongoing review of all concepts prior to and after client approval. Creation and maintenance of concept validation procedures to include: scheduled validation of all concepts including reference and documentation, monitoring of concept performance to assist in early identification of issues and review of all associated concept documentation.
Validates New Claim Types
With proficiency, utilizes audit tools to evaluate, document and validate new claims and concept effectiveness. Assists team with ensuring that any new and existing concepts are achieving desired goals in terms of recoveries, collectability and client acceptance.
Education, Experience, Abilities
Associates Degree minimum or equivalent relevant healthcare experience required;
Bachelor’s degree in nursing, HIM or related health field preferred;
AAPC or AHIMA coding certification preferred.
Skills and Experience
Computer proficiency in Microsoft Excel, Word, PowerPoint and Access
Minimum of 5 years of experience in medical billing, inpatient or outpatient coding, auditing or CDI
Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
Proficient with Medicare reimbursement methodologies, billing guidelines, and applicable industry-based standards
Proficient with all healthcare coding (CPT4, HCPCS, DRG, ICD-9 and ICD-10, Home Health, SNF, Revenue Codes, etc.)
Proven industry expertise within Hospital, Home Health, Hospice, DME, SNF or Physician Billing
Proficient with healthcare claim adjudication standards and procedures
Excellent verbal and written communication skills
Strong analytical and investig…
Auditing , Medical Billing , Medical Coding , Analyst