Solutions Analyst Jobs

• Independently develop and enhance payment integrity rules by translating medical policy and coding guidelines into scalable rule logic.
• Conduct complex claims and data analysis to identify policy opportunities and rule enhancements.
• Own the development and quality of policies and rules within assigned domain areas.
• Perform quality assurance validation to ensure policy logic accuracy and consistency.
• Collaborate with Product, Engineering, and Operations teams to support the implementation of new rules and policy enhancements.
• Provide subject matter expertise in coding interpretation, reimbursement methodologies, and policy development.
• Mentor junior analysts and provide peer review support for rule development and analysis.
• Contribute to process improvements and identify new content opportunities.
• This position requires intermediate guidance from mentors and leadership.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

• Master’s degree in Genetic Counseling or related field (e.g., Molecular Genetics)
• Board certification preferred (ABGC or equivalent).

• 6-8+ years in genetic counseling, molecular diagnostics, and/or laboratory utilization management.
• Strong preference for experience in payer, lab benefit management, or advisory environments translating clinical guidance into operational or policy frameworks.
• Deep knowledge of CPT/HCPCS coding for lab/genetic testing, including NGS panel billing complexity and common billing patterns (e.g., stacking and unbundling).
• Ability to translate clinical nuance into structured, scalable rule logic for prepay and postpay payment integrity solutions.

Core Competencies

• Strong analytical, critical thinking, and problem-solving skills including clinical-to-technical translation.
• Strong communication and client-facing presentation skills.
• Cross-functional influence and collaboration.
• Ability to balance savings opportunity with provider abrasion risk.
• Proficiency in Microsoft Office Suite.
• Excellent interpersonal, verbal, and written communication skills.

• Experience supporting client-facing engagements or presenting to payer stakeholders
• Exposure to utilization analytics, claims data interpretation, or payment integrity programs

• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Making timely decisions in the context of a workflow.
• Maintaining focus.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• Learning new tasks and completing tasks in situations that have a speed or productivity quota.
• Remembering and adhering to processes and protocols.
• Applying established protocols in a timely manner

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Communicating with others to exchange information.
• Repeating motions that may include the wrists, hands and/or fingers.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• No adverse environmental conditions expected.
• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.
• Flexibility and willingness to participate in the work processes of an international organization.