Clinical Consultant II at Cotiviti


Clinical Consultant II (Remote) (Coding / Medical Policy Expert)

Clinical Operations CLINI03787


Nationwide (Remote)

Job Details


The Clinical Consultant II provides expert consultation during the planning through operations phases, regarding coding regularity requirements and clinical policy guidelines. This role works with a team of others: Medical Director, Client Managers, and Financial professional to deliver and implement clinical & coding guideline changes to their assigned clients.


  • Provides expert consultation during the planning through operations phases, regarding coding regularity requirements and clinical policy guidelines.
  • Function as a key member of the implementation team to collect, collate and articulate the client’s clinical and payment policies.
  • Acts as the key liaison for the clinical information between internal partners and external customers during operations phases.
  • Responds to client inquiries in a timely manner in compliance with policy and procedures.
  • Works collaboratively with the Account Manager and Sales Executive to develop excellent client relationships.
  • Provides clients with high quality and customized analysis of quarterly and ad hoc reports and recommends new reports that would be useful to their clients.
  • Assists the Clinical Content Team with research of new trends and applications for new rules.
  • Provides support to the sales team when presenting clinical information to prospective clients as needed.
  • Provides client support during user acceptance testing.
  • Completes all responsibilities as outlined on annual Performance Plan.
  • Completes all special projects and other duties as assigned.
  • Must be able to perform duties with or without reasonable accommodation


  • Active professional license as a Registered Nurse (BSN preferred) or Bachelor’s Degree in Healthcare related field or equivalent relevant experience.
  • CPC or equivalent certification required.
  • Minimum of 3 years clinical coding experience, preferable in a payer setting.
  • Proven competence as Clinical Consultant I or equivalent expertise/skill that possesses knowledge of healthcare claims payment policy and processing, specifically, CMS, Medicaid, ICD, CPT, HCPCS and other specialty society, etc.
  • Proficiency in Microsoft Office suite.
  • Familiarity with claims payment and reimbursement methodologies.
  • Ability to analyze complex data and synthesize it for customer and internal consumption.
  • Ability to work well both independently and collaboratively, in a fast-paced and demanding environment.
  • Effective at managing timelines and multiple projects.
  • Effective presentation, verbal and written communication, and interpersonal skills.
  • Ability to travel approximately up to 10% of the time (likely less).

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

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