Position Details

Salary $110K – $130K USD / year

Type Full-Time

Experience mid

Exp. Years 8 years

Education Pharmacist degree (BSPharm or PharmD)

Category Healthcare & Medical

About this role

Pharmacist-led role focused on research, QA, and policy analysis for pharmacy claims edits; responsible for coding logic, policy rollout, and collaboration with product and field teams.

Key Responsibilities

Familiarity with claims payment and reimbursement methodologies and medical policy rules and edits
Analyze complex data for customer/internal use
Write business logic for new rules
Provide input to rule engine developers
Support policy roadmap

Technical Overview

Clinical coding expertise with CPT/HCPCS/ICD/NDC; policy rule development and rule engine input; data analysis and MS Office proficiency.

Ideal Candidate

The ideal candidate is a licensed pharmacist with strong experience in pharmacy policy and coding rules for payer environments, plus 5+ years in policy rule gathering and Cotiviti-related work. They should be comfortable with clinical coding and policy development in a remote setting.

Must-Have Skills

Pharmacist with 3+ years clinical/retail payer experience5 years experience in coding research or Cotiviti role5 years experience in detailed rule requirement gathering and software enhancements

Nice-to-Have Skills

RHIARHITCPCCPC-HCCS-PSAFeCPhTWillingness to obtain certification within one year

Tools & Platforms

Microsoft Office Suite

Required Skills

PharmacistCPTHCPCSICDNDCpharmacy policyrule enginecodingdata analysisMicrosoft Office

Hard Skills

CPTHCPCSICDNDCpharmacy claims editingcodingrule engine developmentMicrosoft Office Suite

Soft Skills

analytical thinkingcritical thinkingcommunicationattention to detailmentoringteamworkproblem solvingtime management

Certifications

Preferred

RHIARHITCPCCPC-HCCS-PSAFeCPhT

Industry & Role

Industry Healthcare & Medical

Job Function Develop and implement pharmacy policy coding rules for Cotiviti policy library

Role Subtype Pharmacist

Keywords for Your Resume

Content Solutions Analyst II - RXCotivitipharmacistpharmacy claims editing policyCPTHCPCSICDNDCclinical codingrule enginecoding rulespharmacy policy libraryMicrosoft Office Suitedata analysisQAGrooming sessionspolicy rolloutpharmacy claims editingcoding

Deal Breakers

Pharmacist without 3+ years of clinical/retail payer experience, Lack of coding rule development experience

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