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This Coding Validation Analyst I position will perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical knowledge and background to ensure appropriateness for reimbursement and will also respond to provider appeals. This position requires strong organizational skills and the ability to meet strict key performance indicators in a fast-paced work environment. Daily, substantive contact with internal staff.
This is a closely monitored productivity-driven role and can be done anywhere in the continental US (this is shift work and hours need to be flexible...this team runs 24 x 7)....
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The Solution Analyst sits within Cotiviti’s Business Architecture organization and serves as the connective tissue between business strategy and technical delivery. Partnering with Research & Development (R&D), product management, and operational stakeholders, this role translates strategic priorities into well-defined solution requirements, evidence-based process designs, and product decisions that advance Cotiviti’s mission to reshape the economics of healthcare.
Reporting to the director of business architecture, the Solution Analyst is expected to bring rigor, curiosity,...
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The Senior Auditor, Appeals position is part of the Clinical Chart Validation (CCV) team and is responsible for defending Cotiviti’s recovery determinations utilizing the appropriate guidelines including but not limited to Commercial, CMS inpatient and outpatient coding guidelines, coding clinics, and internal clinical validation policies if applicable. The appeals auditor is responsible for performing an extensive review of the initial claim along with the associated documentation as well as any additional information submitted by the provider on appeal. The appeals auditor will render a decision, and formulate a written response, on each claim reviewed providing the most accurate decision...
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The Medical Policy Director (MPD) is a key member of the Go To Market team. Along with the Client Engagement Leader, Client Medical Director (CMD), the MPD co-captains the team serving the Prospective Payment Management (PPM) client team at the health plan. The MPDs role is to serve as a coding and medical payment policy subject matter expert (SME), with the assistance of a CMD. The MPD is responsible for directing the Medical Policy Committee (joint committee with health plan MD, coding experts, and payment integrity). The MPD will develop a relationship with the client, review their data, select medical policy to present, serve as SME for clinical and coding expertise, and back-end support for...
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This role is part of the training team for the Clinical Chart Validation team. This position is responsible for improving the technical effectiveness of our teams by planning, developing, and delivering technical training, mentoring, and assessment. The individual will work collaboratively with subject matter experts in the Commercial & Government Audit Teams, Quality Assurance, Concept Development, and others to validate workflows and communication tools to enhance audit productivity, performance, and client satisfaction.
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A Payment Accuracy, Coordination of Benefits (COB) Specialist 2, is a member of the greater Coordination of Benefits Business Unit (BU). Coordination of Benefits involves situations in which an individual is covered by two or more health plans.
The Payment Accuracy, Coordination of Benefits (COB) Specialist 2 position is essentially a subject matter expert (SME), provides innovation to introduce new ideas, research as well as creative thinking. This individual will have the opportunity to demonstrate multi-client...
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The Policy Design Specialist role is responsible for managing health plan clients and executing monthly project requests. Perform policy configuration maintenance of current medical policies along with implementing new health plan medical policies per client request. Adhere to and remain in alignment with the most up to date healthcare industry medical coding guidelines. Perform data analysis to determine how to accurately apply coding updates and client requested customizations. Execute quality assurance checks to ensure appropriate claim editing recommendations are applied based on client request.
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The Senior Product Manager – Edifecs is the liaison between business stakeholders, product management leadership and engineering managers. This role works with these stakeholders to understand current and future needs related to one or more products and/or modules and iteratively develop product features to evolve products based on product roadmap. Senior Product Manager – Edifecs is well versed with working in agile / scrum framework, software development lifecycle and uses this expertise to bridge gap between customer facing product management and engineering /...
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As a Business Development Representative (“BDR”), you will support the growth of the sales pipeline and expand target account intelligence for Cotiviti. The BDR frequently is the voice of Cotiviti, which sets the tone of the customer experience, particularly in first-contact situations. You will support the management of sales territories by establishing relationships, conducting introductory conversations, and gathering intelligence that enables Cotiviti to favorably compete for the prospects’ business. BDRs support analysis and reporting needs of sales operations by developing business profiles of targeted accounts, also referred to as “New Logos.” BDRs also support marketing program development by...
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The Project Manager – Payment owns delivery of defined project(s) from initiation through close. Ensures plans are realistic, stakeholders are aligned, execution stays on track, and risks/issues are actively managed.
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The focus of the VP, Client Engagement is to develop and execute against growth, renewal and retention strategies on their customers within the top customer tier. The VP Client Engagement is accountable for the coordination and transparency needed to drive a successful, multi-pronged growth and retention strategy as well as a multi-level relationship engagement across the customer leadership team.
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Join a recently formed team focused on Model Risk and Responsible AI. The Senior GenAI Scientist II – Risk will apply knowledge and experience to real world problems and seek to utilize their skills to reduce the cost of healthcare and improve health quality and outcomes. As a Data Scientist on this team, you will focus on three main project areas: Model Validation, Model Metrics and Monitoring, and Responsible AI. This requires someone with depth in
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Join a recently formed team focused on Model Risk and Responsible AI. The Generative AI Scientist - Risk will apply knowledge and experience to real world problems and seek to utilize their skills to reduce the cost of healthcare and improve health quality and outcomes. As a Data Scientist on this team, you will focus on three main project areas: Model Validation, Model Metrics and Monitoring, and Responsible AI. This requires someone with depth in AI/ML/GenAI from a data...
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The Client Medical Director (CMD) is a key member of the Go To Market team. Along with the Client Engagement Leader, the CMD co-captains the team serving the Prospective Payment Management (PPM) client team at the health plan. The CMDs role is to serve as a coding and medical payment policy subject matter expert (SME). The CMD is responsible for directing the Medical Policy Committee (joint committee with health plan MD, coding experts, and payment integrity). The CMD will develop a relationship with the client, review their data, select medical policy to present, serve as SME for clinical and coding expertise, and back end support for the client’s Medical Director. The CMD will evolve as the trusted advisor for the Health Plan...
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We are looking for a Senior Principal Machine Learning Engineer to lead the design and delivery of end-to-end ML/AI systems that turn vast volumes of claims, clinical, and member data into measurable performance and reduced waste. You will define technical strategy, drive cross-functional alignment, and own systems that directly shape payment accuracy, risk adjustment, and quality outcomes for the payers we serve. This role sits at the intersection of applied research and production engineering, translating ambiguous, high-stakes problems into...
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Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality.
The Software Engineer is responsible for the design and development of software applications and reusable software components for the Cotiviti Inc product suite, in compliance with...
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The Product Manager – Fraud, Waste, and Abuse (FWA) is responsible for driving the strategy, development, and lifecycle management of Cotiviti’s FWA product suite, including advanced analytics-driven solutions designed to identify and prevent improper healthcare billing. This role works at the intersection of product, analytics, operations, and client engagement to deliver high-impact solutions that improve payment integrity outcomes for healthcare payers.
The Product Manager partners closely with cross-functional teams including R&D, data science, operations, implementations, and...
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This DRG Validation Auditor role is focused on our Cross Claim Clinical Reviews (CCCR). Auditors in this role will be doing DRG Validation for our prepay and retrospective audits and making determinations without a medical record. The ideal candidate for this position needs to have both a strong inpatient HIM/coding background and an understanding of clinical validation. This position is responsible for auditing inpatient claims and documenting the results of those audits, with a focus on clinical review, coding accuracy, and the...
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The Drug and Biological Policy (D&B) Content Analyst II is a key member of the clinical operations and content team and is responsible for the research, quality assurance, and maintenance of existing D&B policies. This individual is expected to define additional logic and algorithms to expand the D&B Library and add value for our clients who implement this policy.
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The AI Engineer Intern focuses on researching and developing advanced healthcare informatics, particularly in the realm of emerging Artificial General Intelligence. It is designed to support improvements in healthcare treatment, payment, and operations. The intern will support multiple projects to set up the underlying architecture, such as context layer for data agents, setting up guardrails and governance.
We are currently looking for interns who can...
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This auditing role will focus on Coding & Clinical Chart Validation for our Outpatient and Specialty audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on one of the following disciplines from a coding and billing perspective: SNF, IRF, Home Health, APC, ER, Diagnostics and Professional Service. This position is responsible for auditing outpatient/specialty claims and documenting the results of those audits. with a focus on clinical review, coding accuracy, medical necessity, and the appropriateness of treatment setting, and services delivered.
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Our Healthcare Data Analytics company seeks AVP Engineering within our Payment Integrity business. In this role, you will lead, direct, and manage the cross-functional technology delivery team. You will handle all the operational aspects of software development to deliver business and project objectives. In addition, you will provide technical, administrative, and people leadership for multiple, diverse, geographically...
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The Sr Data Scientist - Generative AI II will apply knowledge and expertise to real world problems to enable healthcare organizations to deliver better care at lower cost through advanced technology and data analytics, helping to ensure the quality and sustainability of how healthcare is delivered in the United States. With access to dedicated on premise and cloud based big data solutions, the team can work with a vast amount of structured and unstructured data including claims, membership, physician demographics, medical records and others to begin to solve some of the most pressing healthcare issues of our time. A Data Scientist at Cotiviti will be given the opportunity to work directly...
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Cotiviti works with more than 200 healthcare payers and health systems, including all of the top 25 plans in the United States, to deliver higher-performing payment accuracy, risk adjustment, quality improvement, and consumer engagement programs. We take in billions of clinical and financial data points, analyze them, and help our clients discover ways they can improve the efficiency and the quality of care.
The Implementation Director will guide the delivery of services and technology to one or more clients by planning, supporting, and managing implementation activities from...
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The Sr. Auditor, Quality Assurance position is responsible for ensuring that the audited claims meet quality standards necessary to generate high quality recoverable claims for the benefit of Cotiviti and our clients. Audited claim types include: Outpatient and Specialty Review Types to include SNF, IRF, HH, DME, Hospice and medical necessity. Quality assurance emphasizes compliance with established procedures, accuracy of claim identification and supportive documentation. Identifies and notifies management of observed quality and communicates opportunities for process improvements based on independent audit claims review. Displays professional...
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As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role.
This role aligns with our post-pay Fraud Waste & Abuse team.
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As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role.
This role aligns with our post-pay Fraud Waste & Abuse team.
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The Client Policy Manager I manages client payment policies by ensuring client’s payment policy is accurate, up-to-date, and complete; executes client-specific requests with guidance from internal team and acts as the internal and external client team liaison.
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We are seeking a seasoned Director of Data Engineering to lead and scale a high-performing, enterprise-grade data engineering organization for a healthcare company with petabytes of data. This role is responsible for architecting and governing the data infrastructure and drive the technical roadmap across foundational infrastructure, streaming pipelines, analytics engineering, and AI enablement, and serve as a strategic partner to product, analytics, clinical informatics, and technology leadership
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This internship centers on researching and developing advanced healthcare informatics solutions with a specialization in Agentic AI—AI systems capable of autonomous reasoning, decision-making, and goal-directed behavior. The intern will explore applications of Agentic and Generative AI in healthcare, supporting improvements in treatment, payment, and operations. You will play a key role in developing, analyzing, and collaborating on
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Technical Architect II designs and evolves intelligent workflow and automation solutions in an AI-native development environment. This role combines expertise in application architecture, workflow orchestration, and enterprise platforms with AI-assisted engineering tools (e.g., Claude, Copilot) to accelerate solution design, code generation, and SDLC execution.
The architect will support the Payment BU Workflow Intelligence & Orchestration Initiative, collaborating on client inquiry and payment workflows, while contributing to a Center of Excellence (CoE) for...
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A Senior Revenue Cycle Specialist is a member of the Revenue Cycle team within the Yield Management Division. This department may work directly with other members of Yield to ensure department expectations are accomplished. The Sr. Specialist, Revenue Cycle position is responsible for complex levels of recurring and/or daily functions and processes that are necessary for business execution; including but not limited to, ensuring the quality of various functions within the department (check application, offsets, invoicing,...
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Staff Engineer I (AI, Java) is a senior hands-on technical leader responsible for designing and building intelligent backend services and workflow-integrated solutions within an AI-native development environment. This role combines deep expertise in Java-based systems and workflow orchestration with AI-assisted engineering (Claude, Copilot) to enable scalable automation, intelligent routing, and decisioning.
The role partners with Technical Architects and leads engineering teams to deliver secure, scalable, and reusable services across enterprise workflow platforms.
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Senior Software Engineer (AI) is a hands-on role responsible for building intelligent backend services and workflow-integrated solutions within an AI-native development environment. This role combines strong Java-based engineering expertise with enterprise workflow orchestration to enable automation, intelligent routing, and AI-assisted decisioning. The engineer will support the Payment BU Workflow Intelligence & Orchestration Initiative, collaborating with Technical Architects and engineering teams to deliver scalable, secure, and reusable services across workflow platforms.
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We are looking for an Recovery Resolution Specialist (Collections) to join our Yield Management team! This role will facilitate the collection of funds for the client and maintains exceptional provider relations. Works closely with audit team, payers and providers to understand claims and or concepts to facilitate effective communication and collection. Engages in verbal and written communication involving the provider, audit staff and client. Identifies problems in the collection process for escalation to the appropriate parties.
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The Generative AI Research Engineer Intern conducts primary and secondary research of advanced and emerging healthcare informatics technology with a focus on Generative AI and emerging Artificial General Intelligence technology for healthcare treatment, payment, and operations use cases. Creates research papers, analytical reports, proposals, and educational material. Maintains a deep understanding of technology trends and hands-on experience with relevant technologies. Develops generative AI models, architectures, databases, and systems to improve healthcare solutions.
We are currently looking for interns...
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The Senior Solutions Consultant serves as Cotiviti’s subject matter expert and “voice of product” for our consumer engagement solutions and broader Health Enablement offerings. This role partners closely with Sales, Product, and Client teams to pursue strategic opportunities, deliver compelling demonstrations, and provide deep expertise on member and provider engagement, intervention planning, and healthcare activation workflows.
The Senior Solutions Consultant bridges the gap between customer needs and...
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Cotiviti is seeking a Director of Engineering to lead multiple software engineering teams within our Payment Integrity business. In this role, you will provide strategic and technical leadership across one or more product domains, leading through engineering managers and team leads to deliver high-quality, reliable software solutions.
You will champion an AI-native approach to software delivery by integrating AI...
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This is a highly visible senior strategic individual contributor role within Cotiviti’s National Accounts segment, with the opportunity to shape growth across some of the most important payer relationships in the market. The role is responsible for accelerating sales growth across Cotiviti’s full Healthcare portfolio by building executive relationships, advancing complex enterprise opportunities, and delivering strategic value to national health plans. Extensive experience and a demonstrated track record of selling enterprise solutions to Health Plan C-level executives, SVP business owners, procurement leaders, VPs, and directors are essential. We are seeking remote...
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We are seeking a highly experienced Principal Software Engineer to design and build the backend infrastructure for our centralized AI platform. This role will focus on developing robust, scalable backend services that power our agentic framework and enable teams across the company to securely deploy, manage, and access AI agents through unified APIs and user interfaces.
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The Content Analyst II is a key member of the clinical operations and content team responsible for the research, quality assurance, and opportunity analysis associated with new medical policies. In addition, this position will be responsible for review and analysis of current medical policies and assisting in the research necessary to define additional logic and algorithms to expand the Cotiviti payment policy library.
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The Strategic Pricing, Director is a member of the Corporate Development and Strategy team at Cotiviti. This person will be responsible for leading Cotiviti’s pricing strategy, including maintaining the company’s existing pricing and creating pricing models for new solutions. This person will...
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The Senior Manager, Revenue Cycle Operations leads a team of Business Operations Analysts and Revenue Cycle Specialists supporting Cotiviti’s Clinical Chart Validation (CCV) operations and client delivery. This leader oversees revenue cycle management, month-end close activities, inventory management, client SLA delivery, and financial analysis for assigned clients within the Clinical Chart Validation business unit. The role is accountable for maximizing revenue recognition, minimizing financial leakage, strengthening process controls, and accelerating client savings value while serving as a trusted internal and client business partner. This position also supports workflow modernization through...
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The Corporate Development Associate is a member of the Corporate Development and Strategy team at Cotiviti. This person will be responsible for evaluating strategic acquisitions for Cotiviti, as well as supporting end-to-end M&A execution and corporate development initiatives across Cotiviti’s portfolio of products. This person will identify and evaluate new opportunities, conduct due...
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The focus of the VP, Client Engagement is to develop and execute against growth, renewal and retention strategies on their customers within the top customer tier. The VP Client Engagement is accountable for the coordination and transparency needed to drive a successful, multi-pronged growth and retention strategy as well as a multi-level relationship engagement across the customer leadership team.
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The Cotiviti Retail Business Process Optimization (BPO) Team is seeking a Manager to work closely with our operations, R&D, and client teams. We are looking for an individual who is a self-starter, interested in developing their own skills and experiences as well as being a trusted go-to resource for other BPO team members. We are looking for an individual who is technically sound but also curious and interested in learning our unique and results oriented business. This individual must possess a complete understanding of retail audit recovery work, best practices for managing audit teams, great interpersonal skills and be comfortable with conducting...
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Cotiviti is seeking a Director, Business Architecture to build and lead the Business Architecture capability for the Payment Integrity business unit. This role will define how the business needs to work to support scale, reduce fragmentation, improve business-to-technology alignment, and enable more efficient execution across the operating model.
This leader will clarify business capabilities, value streams, ownership, decision paths, and target-state operating models; identify redesign opportunities; and create the foundation for automation, AI enablement, innovation, and scalable transformation. The role requires a strategic leader who...
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The Data Engineer is responsible for architecting, developing, and maintaining scalable data infrastructure and pipelines that enable robust analytics and reporting solutions. This position establishes, runs, and sustains best practices for Big Data, Analytics, and Reporting applications in multiple environments, with a strong emphasis on data quality, integrity, and accessibility. The role includes performing data gap analysis, developing and maintaining a semantic layer, and leveraging Databricks for efficient data processing and quality assessment.
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As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role.
This role aligns with our pre-pay Fraud Waste & Abuse team.
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The Senior Counsel, Partnerships will be the main legal resource overseeing strategic partnership contracting. The role will also support the Director, Senior Corporate Counsel in overseeing the full life cycle of Cotiviti’s healthcare and non-healthcare vendor contracts – from initial negotiation through execution, ongoing management, renewal, and termination. This role will be responsible for reviewing, drafting, and negotiating a broad range of commercial agreements, including master services agreements, license agreements, SaaS agreements, business associate agreements, non-disclosure agreements, and other related commercial agreements. The ideal candidate will have...