Cotiviti · 1 month ago
Clinical Consultant I
United States
Full-time
Remote
Entry, Mid Level
$75K/yr - $92K/yr
2+ years expCotiviti is a healthcare solutions company that is seeking a Clinical Consultant I to support Clinical Services teams in the validation of quality and processes consistency on the CPE editing engine. The role involves providing subject matter expertise on Coding Validation to clients and internal stakeholders, ensuring effective communication and collaboration throughout the project lifecycle.
Responsibilities
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, assessing impact of decisions for affected policies, and communicating effectively with the client to address questions or clarify information
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
Appropriately and effectively communicate quality review results and revisions (if applicable) to clients when they occur
Provide action plans to mitigate future issues as needed with Quality Team in close internal collaboration
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, updates to existing rules, and development of new editing
Assist the Clinical Content Team with feedback from a client perspective on new trends and application of new rules
Work with Quality, Training, and Operations Teams as needed to facilitate any updates in CV review guidelines, effectively communicate changes in client specific review, and address other CV client issues in an accurate and timely manner
Support resource for the Clinical Services team on Coding Validation implementations, including reviewing test claims, and internal go-live support
Act as a support liaison for appeals management process
Support CPE Clinical Services quality assurance processes including pre and post release testing and other areas of need as identified
Assist the Clinical Content Teams with validation and review of client payment policies
Maintain Client Information Workbooks with updated information as needed to maintain accuracy in CV review
Provide support during user acceptance testing in Nucleus
Qualification
Required
Associate or Bachelor's degree in Nursing (active/unrestricted license)
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
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 working for a managed care or healthcare insurance company, or related experience
1+ years of experience in customer service or client management with a strong focus on healthcare setting
Ability to analyze complex data and synthesize it for customer and internal consumption
Strong research capabilities and knowledge of CMS guidelines and other regulatory compliance guidelines and mandates, and medical payment policy
Proficient with Microsoft Office Suite (Word, Excel, Power Point)
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 properly handle confidential information
Ability to work well independently and a track record of successful outcomes within a collaborative team environment
Ability to work in a fast-paced environment, effectively organize, prioritize and meet deadlines
Strong written and verbal communication and interpersonal skills
Ability to work with remote cross-functional product teams
Computer and technology literate
Must have ability to positively handle/manage stress, such as high work volume and frequent change
Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones
After hours and/or weekend work may be required where necessary for major deliverables/deadlines (not consistent)
Travel requirement up to 10%
Ability to analyze complex data and synthesize it for customer and internal consumption
Detail oriented
Effective analytic and problem-solving skills
Professional with ability to properly handle confidential information
Ability to work well independently and a track record of successful outcomes within a collaborative team environment
Ability to work in a fast-paced environment, effectively organize, handle multiple tasks, prioritize and meet deadlines
Ability to work with remote cross-functional product teams
Must have ability to positively handle/manage stress, such as high work volume and frequent change
This remote role can be located anywhere in the continental US
Repeating motions that may include the wrists, hands, and/or fingers
Must be able to provide a dedicated, secure work area
Must be able to provide high-speed internet access/connectivity and office setup and maintenance
Must be able to sit and use a computer keyboard for extended periods of time
No adverse environmental conditions expected
Preferred
Working knowledge of Cotiviti systems preferred
Demonstrates basic working knowledge of the following applications within 90 days of hire: Nucleus, JIRA, Mantis, MicroStrategy, Tableau
Benefits
Medical
Dental
Vision
Disability
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
Company
Cotiviti
Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States.
5001-10000 employees
H1B Sponsorship
Cotiviti has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (165)
2024 (118)
2023 (90)
2022 (102)
2021 (72)
2020 (67)
Funding
Current Stage
Late StageLeadership Team
Adam Gilbert
Director, Interoperability Operations and Partnerships
Chris McIntyre
Sr. Program Manager, RQNC Operations
Recent News
2024-04-07
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