Receive alerts when this company posts new jobs.
Research Analyst 1 - Operations Growth Strategy
Cotiviti is looking for an industry leading Research Analyst I, Operations to join a revolution in Healthcare Technology and build a first-in-market analytic capability. The Research Analyst I, Operations works directly with Research Analysts IIs (RAII), Sr. Research Analysts (SRA) and Research Strategists (RS) to create business requirements for algorithms and then test return results (opportunities) to ensure they are consistent with the types of medical claims intended to be captured by the algorithm. The goal of the position is to ensure that all client/policy customizations are properly configured and that all potentially overpaid claims are included in the opportunity universe with minimal amount of false positives (i.e. claims paid correctly).
A Successful Candidate in this role Should be:
- Curious: You enjoy breaking down a problem and examining the interrelationships between data that may appear superficially unrelated.
- Creative: You constantly invent and try new approaches to solving problems, which often times have never been applied in such contexts before.
- Practical: You explore theories with an eye to the real world application to the business and the potential for improving performance for clients and customers.
- Focused: You're intent on designing and testing a technique over periods of days and weeks, discovering what is successful and what should be optimized further.
- Determined: You will have both the challenge and opportunity to help design our analytical backend from the ground-up, and therefore must be comfortable as both a team member and a leader in our data science effort.
- Client Knowledge – Assists RAIIs and SRAs, the subject matter expert, in maintaining client value assets. This includes working knowledge of client processing systems, client payer policy, market landscape, data, provider contracts and the policy/content approval process. This knowledge will be called upon to collaborate with cross functional teams including Go to Market, Solutions, Digital.
- Content Development - Assists RAIIs and SRAs, the subject matter expert, in existing content and developing new content. The RAI will collaborate with Enterprise Research to capture and document supporting reference data, root cause to the payment inaccuracy and initial opportunity impact analysis. They will also collaborate with BPAs to determine the audit workflow and document for the job aids. This knowledge will be called upon to collaborate with audit teams for production implementation.
- Edit Parameter Development - Assists RAIIs and SRAs, the subject matter expert, to create edit parameters that are incorporated into algorithms in order to identify medical claims that might result in an improper payment. Identifies opportunities to refine algorithm criteria to enhance the result set while ensuring maximum content coverage. Insures that all algorithms and content is maintained and documented in the content library or other information management system.
- Report Validation. - Assists RAIIs and SRAs, the subject matter expert, to identify potential opportunities to improve accuracy and efficiency of algorithms. Reviews medical claims that qualify for algorithms to ensure that claims fall within the universe of claims intended to be captured by the algorithm thus eliminating properly paid claims. Works with data analysts and engineers to validate that algorithm configuration is consistent with the IP definitions.
- Algorithm Configuration/Integration into Rules Engine. - Works with cross functional teams to ensure that the algorithm definitions and logic are consistent with client/policy customization needs. Assist Research Analysts, II and Sr. Research Analysts, who are responsible for configuring the algorithm in the rules engine, to ensure that the configuration is accurate. Work with key constituents to establish effective feedback to consistently monitor algorithm performance.
- Gap Analysis. - Compares edit parameters across multiple algorithms used by the business to identify inconsistencies that would lead to different opportunities. Assists RAIIs and SRAs as the subject matter expert subject matter experts to identify standard edit parameters where inconsistencies exist. Works with business analyst to implement modifications and ensure that algorithm results are accurate.
- People Development/Mentoring: Associate is in a learning mode 20% of the time. At least 3 associates can demonstrate learning at least 3 technical or knowledge skills from a Proficient associate over the course of a year. New associates are partnered for onboarding with this associate near the beginning of their tenure. At least 5% of this associate's time is spent developing technical and/or knowledge skills within other associates.
- Project Management: Ability to identify issues and risks; Ability to manage stakeholder relationships to help drive issue resolution - includes summarizing project health and outcomes at any point in the project lifecycle; Ability to articulate a project's scope, key processes, accountable owners and stakeholders and project milestones and timelines.
- Business Development: Associate receives some leads from manager and has developed several of their own leads. Requires some peer or manager interaction to complete concept development. There are gaps in understanding about how the opportunity impacts all business areas. Independent analyses done at least 25% of the time. Business cases are simple-moderate and require some support and manager sign-off. Directly supports implementation of own concepts and less than 50% questions are answered with management.
What we are looking for:
- Bachelor’s degree or equivalent experience
- Minimum of 2 years of related, claim auditing experience and process mapping experience.
- Working knowledge of medical claims processing and reimbursement, including facility and professional claims
- Knowledge of CPT codes, procedure codes, revenue codes, and DRGs
- Strong knowledge of Microsoft Access
- Ability to understand SQL statements and identify results to ensure consistent with SQL statements
- Experience in Agile environment
- Must be able to sit and use a computer keyboard for extended periods of time
- Synthesizes business needs, patterns in data, and implementation constraints to create value without oversight. Able to give requirements, conduct user testing and recommend resolutions to avoid data quality issues.
- Associate effectively utilizes & conveys concepts within the team's specialty area; some exposure to "the big picture" horizontally & vertically; demonstrates knowledge of managed care and program integrity role.
- Content documentation is clear and accurate with limited errors. Content validation steps are followed. Management support is required when answering questions or defending content to other business areas. Less than 50% of content are sourced from a variety of resources (e.g. policies, data analysis, outlier reports, etc...)
- Associate understands basics of coding, and medical terminology, but researching basic information is still required. Example: Associate may have physician and outpatient knowledge, but is very limited on inpatient coding, or associate may have knowledge in all types of coding but has not obtained the Certification.
- Associate can communicate effectively with peers in the same specialty area to get the job done. Only basic skills with Word/Excel/PowerPoint.
- Associate is in a learning mode 60% of the time. Associate can share basic resources (SharePoint, Analysis Templates, and P&PS) with new associates.
- Ability to manage basic project progress; Document project scope, deliverables, milestones and timelines.
- Associate receives majority of leads from manager. Requires manager or high level of peer interaction to complete concept development. Little independent analysis done. Business cases are simple and require support and oversight. Implementation of concepts are done outside of the associate and questions are answered with management.
- Attention to detail and accuracy
- Organizational skills
- Desire and capacity to learn new concepts and software
- Strong analytical and problem-solving ability
- Professional with ability to properly handle confidential information
- Ability to work well independently and in a team environment
- Ability to handle multiple tasks, prioritize and meet deadlines
- Ability to work within a matrix organization