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The Senior Manager, Audit Manager Training leads the design, delivery, and continuous improvement of training and capability-building programs for audit managers and quality audit staff across CCV. This leader owns the curriculum that prepares auditors and audit managers to apply audit guidelines accurately and consistently, including training on AI-supported review tools, human-in-the-loop workflows, and the judgment required to validate AI-assisted findings. The role partners closely with Quality Audit Operations, concept development, machine learning and strategic analytics, and client service teams to translate evolving audit guidelines, quality findings, and...
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The Immigration Counsel will serve as in-house immigration legal advisor to Cotiviti. They will be responsible for partnering with leadership on company immigration operations in compliance with federal and state laws and administrative policies. This person will act as the extensive knowledge on all immigration related activities including, but not limited to, visa caseloads, immigration law, immigration document retention, communications with employees, etc. The Immigration Counsel will draft key documents, assist in the completion and filing of all immigration related paperwork, present clear recommendations, and assure legal compliance. They will handle the preparation of immigration cases, including a variety of temporary work visas and green cards, as...
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A Payment Accuracy, Coordination of Benefits (COB) Specialist, 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. Our specialists are passionate about what they do and are experts at reviewing, discovering, and validating substantial amounts of data and delivering results and insights for our clients.
A Payment Accuracy, COB Specialist, is responsible for reviewing and analyzing claims, member, and group data to identify instances of recoverable claims for the benefit of Cotiviti...
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A Payment Accuracy, Coordination of Benefits (COB) Specialist, 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. Our specialists are passionate about what they do and are experts at reviewing, discovering, and validating substantial amounts of data and delivering results and insights for our clients.
A Payment Accuracy, COB Specialist, is responsible for reviewing and analyzing claims, member, and group data to identify instances of recoverable claims for the benefit of Cotiviti...
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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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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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Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Payment Accuracy Specialist.
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We are looking for a Revenue Cycle Specialist to join our Yield Management team! This role is responsible for the reconciliation and posting of all payments received, identify discrepancies and analyze issues to ensure all payments are posted timely. Other responsibilities include managing inventory and system alignment between Cotiviti and our clients, reconciling data between different sources, research, and the ability to work with cross-functional teams.
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A Lead Solution Consultant will play a pivotal role in driving Cotiviti’s growth by combining deep technical expertise with strong pre-sales acumen across the healthcare payer landscape. This is a client-facing role requiring the ability to lead technical discovery, perform detailed assessments, and design solution architectures aligned to payer business and IT environments.
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The Senior Technical Specialist will collaborate closely with the RCA - Content & Enablement Department, the Implementations Team, and the Audit Operations and R&D teams. This role is responsible for the intake, logic development, deployment, and maintenance of Business Rules that support RCA’s platform applications. The Specialist will also lead efforts to identify and remediate technical limitations, design advanced exclusions logic, and support operational scalability through strategic rule development.
In addition to driving rule implementation, the Senior Technical Specialist will act as a key liaison between the operations team and the BRMS...
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Cotiviti Healthcare is a leader in payment accuracy services, serving top-tier companies in healthcare and retail. We're seeking visionary tech talent ready to revolutionize healthcare systems, drive innovation at scale, and accelerate their career to the next level. Join our dynamic team of problem solvers and lead strategic initiatives that reshape healthcare payment integrity as a Principal Insights Analyst. This role is a key contributor to healthcare team, playing a crucial role in supporting the Payment Integrity area, and will partner closely with other business units, providing both...
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This is a Senior Auditor, Team Lead, with responsibility for supervising a team of Clinical Validation Auditors or other audit team members. Team Leaders ensure that the work of others meets productivity standards, quality guidelines and audit efforts of the client engagement. Primary responsibilities include queue management, work distribution, performance and production optimization, audit planning, auditor interactions, training of new hires/existing staff, Audit Report and Claims writing and support of audit closure activities. The Senior Auditor goal is to ensure the team audits client data on behalf of our clients, generating high quality recoverable claims. Displays professional skepticism that...
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We are seeking a highly experienced Senior AI Engineer to own the development and evolution of two foundational components of our clinical AI platform: the clinical NLP integration layer that connects existing coding infrastructure with the AI pipeline, and the golden dataset pipeline that establishes trusted evaluation standards across the program. In this role, you will design and implement scalable data and AI workflows that enable
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We are seeking a highly experienced Principal AI Engineer to lead the architecture, design, and development of a cutting-edge agentic framework and centralized AI platform that serves as the foundation for the organization's AI initiatives. As the technical lead for the Risk Adjustment (RA) Coding Agent, you will own the end-to-end technical architecture—from clinical NLP integration and production routing to core AI platform components that enable...
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The Principal Product Manager, AI plays an expanded strategic and executional role within the AI Product organization, responsible for owning more complex AI-enabled products or multiple product lines within Retro Claims Accuracy (RCA). This role helps build industry-leading AI technologies that enable lines of business with cutting edge, impactful solutions, and helps accelerate the adoption of AI, including advanced ML and Generative AI techniques, at scale. The Principal Product Manager, AI leads product development, strategy, and performance while driving stronger alignment across business, technology, and customer stakeholders, and guides product ideation, execution, and validation, balancing customer needs with business...
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The Implementation Manager is accountable for the operational execution of the project plan for new customers or new projects specific to existing customers. They will partner with the client services organization to meet client expectations and revenue goals, as well as with any/all internal departments in support of the plan execution to include IT, product, product development, operations, finance, and training. They will define and lead the creation of project implementation project plans, identify process improvement opportunities,
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The Client Services Manager services as the point of contact for clients and is focused on providing the highest level of service to our clients. Role serves as both internal and external client liaison, including triaging, managing, monitoring and support of client related activity, primarily related to Cotiviti Fraud, Waste and Abuse products.
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The Content Solutions Analyst 3 is aligned with our Content and Enablement team, focusing on content optimization, dataset design, and content accuracy. This role partners with various divisions and leadership levels to research, implement, and maintain healthcare policies, billing errors, contract compliance, and duplicate information related to data mining and auditing. It also involves working closely with R&D engineering to QA datasets and ensure content delivery for auditing.
Content Solutions Analyst 3 is responsible for designing and managing content datasets, ensuring their accuracy and compliance with healthcare payment...
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The Sr. Director of Coding will be responsible for coordinating strategic efforts including identifying and implementing operational efficiencies, ensuring product quality and overall client alignment. This role will lead key aspects of the Risk Adjustment Coding area, including but not limited to ensuring overall end to end coding performance meets or exceeds client expectations. In addition to leading operations related to training, quality, and overall production, this role will be a key liaison working directly with clients and vendors.
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The Client Services Manager (CSM) serves as the main point of contact for clients and is focused on achieving plans with clients, revenue retention, and client satisfaction and growth. This role builds and sustains customer relationships and achieves the client’s recognition of Cotiviti as a partner. The CSM’s goals are to ensure that existing clients recognize the value of Cotiviti’s solutions and to sustain/grow the client relationship.
This position is focused on our Clinical Chart...
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The Senior Implementation Consultant assists in the testing and implementation of Edifecs’ solutions purchased by that client. The Implementation Consultant will generally be involved in installing & configuring under the direction of the Technical Project Manager and/or Implementation/Solution Architect. This includes installation of products on client hardware; configuration and development of programs, tasks and guidelines, and setup to fully implement an Edifecs solution. Duties can range from delivery of product training to new client specific requirements, development and deployment. The role involves client coordination and communication as well as technical understanding...
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The Sr. Software Database Engineer is primarily responsible for designing, developing, and maintaining database applications and reusable software components deployed in the Cotiviti product suite, with a strong focus on performance tuning for large-volume data sets and leveraging AI-assisted development tools. You are expected to foster high performing technical teams. You will be required to collaborate effectively with senior developers, offshore development team members, business owners, project management, and other internal stakeholders.
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The Implementation Consultant is a post-sales position focused on individual clients and the implementation of Edifecs solutions they have purchased. This role involves installing, configuring, and overseeing the implementation of Edifecs products for the client. Responsibilities include installing products on Edifecs or client hardware, and configuring and developing programs, tasks, and guidelines to fully implement Edifecs solutions based on the client's specific needs. The Implementation Consultant will serve as the primary technical resource for Client Services, interfacing with the client's technical resources. Duties range from delivering product training to developing and deploying new client-specific requirements. This role...
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The SVP Enterprise Client Engagement and Strategy is Cotiviti's most senior client-facing executive outside the C-suite. Reporting directly to the Chief Growth Officer, this leader carries full business line accountability for Cotiviti's client relationships — owning commercial performance, multi-year area strategy, and the function's contribution to enterprise revenue and growth.
The SVP Enterprise Client Engagement and Strategy is expected to shape how Cotiviti engages Cotiviti’s clients over the next three to five years, drive innovation in how the company...
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The Senior Manager, Quality Assurance leads a team of quality-focused individuals across multiple review types responsible for developing, executing, and continuously improving CCV’s quality assurance programs, and ultimately, delivering value to our clients. This leader oversees the governance of quality standards, criteria, audit guidelines, and monitoring processes to ensure programs are evaluated, maintained, and refined over time. The Senior Manager is responsible for ensuring the accurate application of audit guidelines applied through AI-supported and human-reviewed processes, to support high audit accuracy,...
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The Senior Events Manager is responsible for the strategic planning, execution, and oversight of company events and experiences. This role involves end-to-end event management of events that range in size and complexity, from small meetings to large conferences and trade shows. The Senior Events Manager will leverage their expertise to ensure events are aligned with business objectives, delivered within budget, and meet the highest standards of quality and impact. The ideal candidate is a highly organized, proactive leader with strong project and time management skills and a proven ability to balance strategic planning with seamless execution.
Reporting to the Sr. Director, Events, this role helps translate the enterprise event strategy set by the Vice President,...
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This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient DRG/APR-DRG and/or episode of care. 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 appropriateness of treatment setting and services delivered.
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The Content Solutions Analyst II for Genetic Testing & Laboratory SME is an independent contributor and key member of the Content Solutions Payment Policy Management (PPM) team who owns the development of policies and coverage/coding rules. This position is responsible for research, quality assurance, and opportunity analysis associated with the creation of new rules and the enhancement of existing content, policies, and procedures. In addition, the Analyst II reviews and analyzes current medical policies, mentors other team members, and supports research efforts to identify new logic and algorithms that enhance Cotiviti’s pre-payment policy library. This role actively influences product and...
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The Sr Gen AI Data Scientist I - Generative AI will apply knowledge and experience to real world problems and seek to utilize their skills reduce the cost of healthcare and improve health quality and outcomes. 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...
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The Sr. Software Database Engineer is primarily responsible for designing, developing, and maintaining database applications and reusable software components deployed in the Cotiviti product suite. You are expected to foster high performing technical teams. You will be required to collaborate effectively with senior developers, offshore development team members, business owners, project management, and other internal stakeholders.
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The Vice President, Sales is responsible for the development and strategic execution of annual sales plans to support the acquisition of new clients and sale of new solutions for the Cotiviti Retail division. This is a hunter role focused on hunting new business for Cotiviti’s Retail Payment Integrity Services and Solutions to the world’s largest retailers, e-commerce, and commercial enterprises. Demonstrated experience calling on and selling to “C” level executives, SVP Business Owners, CFO’s, Procurement, VPs, and Directors is essential. Experience working in a disruptive software and services sector selling Data Analytics, Payment Integrity / Recovery Auditing services and...
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Our ideal candidate has a passion for project management, editing, and deadlines! We're looking for an adaptable team member who not only can manage the development and completion of our RFP responses, but also maintain the RFP repository, conduct the RFP reporting, and provide other functions that support our Sales team.
Cotiviti works with some of the healthcare industry's biggest players, so an understanding of technical jargon and industry trends is a plus. Our team is small and collaborative. Solid communication (both written and verbal) and project management skills are a must. As healthcare is constantly evolving, the desire to...
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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 Medical Policy Release Manager is responsible for managing the medical policies releases, release schedule, and IT system related updates. This role oversees
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The Client Services Manager (CSM) is responsible for coordinating the cross-functional client team and is focused on achieving plans with clients, revenue retention, and client satisfaction and growth for the Prospective Payment PPM and CV products. The CSM serves as both internal and external client liaison accountable for triaging, managing, monitoring and support of client related activity. The CSM builds and sustains client relationships, achieves the client’s recognition of Cotiviti as a...
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The Counsel, Government & Regulatory supports the Legal Department by providing legal counsel on government and commercial contracting matters, with a primary focus on federal and state government healthcare programs and associated regulatory frameworks. This role will partner closely with business, compliance, and operational teams to draft, review, and negotiate complex agreements, advise on legal and regulatory risks, and support the Company’s government contracting activities.
The position also supports regulatory initiatives by monitoring and interpreting applicable laws, advising on...
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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 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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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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Cotiviti is a leading provider of data-driven solutions that help healthcare organizations, retailers, and payers improve financial performance and operational efficiency. Our mission is to deliver actionable insights through advanced analytics, innovative technology, and deep domain expertise. As part of our engineering team, you will contribute to building scalable, secure, and high-performing systems that power critical business processes and enable better outcomes for our clients.
The Senior Software Engineer II is a senior technical engineer responsible for...
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This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits (DRG Validation). The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient DRG/APR-DRG. 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 appropriateness of treatment setting and services...
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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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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 Sr AI Product Manager - We are seeking a passionate, talented, and enthusiastic individual to join the AI R&D team and help build industry-leading AI technologies, enabling lines of business with cutting edge and impactful solutions. Not only would you accelerate the adoption of AI but also push the boundaries of advanced ML and Generative AI techniques at scale.
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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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The focus of the AVP, Account Management - GOV is to develop and execute against growth, renewal and retention strategies on all customers within Cotiviti Government Services (CGS). The VP, Account Management 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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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 Senior Software Engineer II role is primarily responsible for the support of the existing software applications and enhanced software components deployed in the Cotiviti product suite. The successful candidate will be required to collaborate effectively with senior developers,...
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The Information Systems Security Manager (ISSM), FedRAMP is responsible for overseeing and sustaining the security authorization and continuous compliance of cloud-based information systems supporting United States Federal Government customers. This role is accountable for ensuring the confidentiality, integrity, availability, privacy, auditability, and accountability of government information systems and associated data.
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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