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.

The Data & Insight Analyst is responsible for architecting and developing best-in-class and innovative analytics and reporting solutions. This role will have responsibility for establishing and sustaining processes and practices that support Big Data, Analytics, and Reporting solutions and applications in an Open Source environment. The Data & Insight Analyst should have a passion for data, working with business people, and creating solutions and driving innovation with a keen interest in mentoring and elevating other technical resources. This role will spend time working independently and as part of a team and will focus on specific deadlines in an Agile development process as defined by the...

Working in an agile software development environment, the Sr DevOps / CI-CD Automation Engineer is responsible for automating build-test-deploy lifecycle for wide variety of applications/services in the cloud. As part of the Advanced Solutions Group team you will focus on enhancing platform services and contributing code to multiple automation projects. You will also utilize engineering and programming skills focused on enabling a DevOps model, participating with Architecture, Operations and Engineering teams within Agile processes. The role will include systems and solution design within the existing architecture, as well as design/implementation of improvements to meet business needs. The Senior DevOps engineer will work...

We are seeking a talented individual for an Investigation Specialist who is responsible for researching medical claim information from insurance companies, gathering third party information from attorneys and insurance adjusters, and verifying attorney representation and/or liability insurance involvement.   The Subrogation Investigation Specialist position is a call center role where your primary responsibility is to support recovery of funds when one of our client’s members has been involved in an accident...

The Policy Testing Analyst role is responsible for testing Medical Policies to ensure product integrity, accuracy and quality. This role serves as a checkpoint by running test scenarios to ensure the medical policies invoke appropriately and are in line with each client’s policy.    This area of our business allows a lot of opportunity for advancement and the Medical Policy team will be considering candidates that are looking to start their career in the corporate healthcare space and is a recent college graduate OR candidates that have been working in healthcare claims, medical policy, or other similar experience.

Cotiviti is currently looking to add an industry leading Data Scientist II, who is focused on machine learning solutions to join our Enterprise Data Science Team and build value-oriented, production level machine learning solutions.  This role is not for research-oriented data scientist, but rather should be of interest to those that want to apply their knowledge and experience to real world healthcare problems and seek to utilize machine learning and artificial intelligence to reduce the cost of healthcare and improve the management of healthcare. With access to dedicated on premise and cloud based big data solutions, this role will work with a vast amount of structured and unstructured data, including claims, membership,...

Cotiviti is currently looking to add an industry leading Data Scientist I QA, who is focused on machine learning solutions to join our Enterprise Data Science Team and build value-oriented, production level machine learning solutions.    This role is not for research-oriented data scientist, but rather should be of interest to those that want to apply their knowledge and experience to real world healthcare problems and seek to utilize machine learning and artificial intelligence to reduce the cost of healthcare and improve the management of healthcare. With access to dedicated on premise and cloud based big data solutions, this role...

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. 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.

Cotiviti is currently looking to add an industry leading Data & Insight Analyst who is focused on architecting and developing best-in-class and innovative analytics, reporting, and support our AI/ML Center of Excellences. This role will have responsibility for establishing and sustaining processes and practices that support Big Data, Analytics, and Reporting solutions and applications. The Data & Insight Analyst should have a passion for data, working with business people, creating solutions, and developing causal relationships that fuel a data-driven culture. This role will involve working independently and as part of a team and will focus on specific deadlines in an...

Cotiviti is currently looking to add an industry leading Data Scientist I, who is focused on machine learning solutions to join our Enterprise Data Science Team and build value-oriented, production level machine learning solutions.  This role is not for research-oriented data scientist, but rather should be of interest to those that want to apply their knowledge and experience to real world healthcare problems and seek to utilize machine learning and artificial intelligence to reduce the cost of healthcare and improve the management of healthcare. With access to dedicated on premise and cloud based big data solutions, this role will work with a vast amount of structured and unstructured data, including claims, membership,...

The Coordination of Benefits (COB) & Data Mining (DM) Audit Support is a member of the greater Coordination of Benefits and Data Mining Business Units (BUs.) This individual will efficiently and professionally handle daily administrative activities within the COB and DM departments to assist the audit to meet and exceed client expectations. This role requires exceptional verbal communication by audio as well as attentive attention to detail for data entry-related written communication and follow–ups for both internal and external client inquiries to achieve success in the generation of overpayments.

At Cotiviti, we are custodians of data for our clients. Using their technical and analytical experience, Data Engineers ensure operational functions are occurring as expected. This includes but is not limited to verifying client files are processed completely and accurately, client data is validated, and clients (both internal and external) are communicated with in a timely fashion when issues arise.

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...

The Medical Director focused on Implementation & Sales is a key member of the Go To Market team. The role is to serve as a coding and medical payment policy subject matter expert (SME). This position is responsible for supporting the sales process for our Payment Policy Management and Clinical Validation lines of business, reviewing and presenting results of the Opportunity Analysis supporting sales, and presenting policy/directing the client toward appropriate policy adoption during the implementation phase.  The Medical Director will then transition the client to a Client Medical Director after approximately 30 days post...

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.

The Technical Specialist role is aligned to our Content and Enablement group within the Coordination of Benefits (COB) team. This role will partner will various divisions and levels of leadership within the whole organization.   A Technical Specialist is accountable to internal customers in the pursuit of implementing new and recurring projects. Manages milestone and task execution within assigned projects and internal process improvement efforts. Directly works with product...

The Technical Specialist role is aligned to our Yield Enablement team within the Enterprise of Data Mining and Payment Integrity. This role will partner will various divisions and levels of leadership within the whole organization.   A Technical Specialist is accountable to internal customers in the pursuit of implementing new and recurring projects. Manages milestone and task execution within assigned projects and internal process improvement efforts. Directly works with...

The Technical Architect provides architectural leadership and guidance in their assigned business area, aligning solution development efforts with the broader architectural vision and roadmap. A Technical Architect’s skills and knowledge must include multiple domains (Application/Solution architecture, Technical/Infrastructure architecture, Information/Data architecture), and experience with Java, Oracle, and...

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...

The Data Solutions Architect provides architectural leadership and guidance in their assigned business area, aligning solution development efforts with the broader architectural vision and roadmap. A Technical Architect’s skills and knowledge must include multiple domains (Application/Solution architecture, Technical/Infrastructure architecture, Information/Data architecture), and experience with relevant implementation technology, platforms, and tools. As a leader, a Technical Architect is expected to influence the assigned organization and work independently with senior business and IT leaders, while acting as a mentor and role model within the development teams. The Technical Architect is...

This is a sales leader role focused on leading at team of field sales executives selling Cotiviti’s healthcare Payment Accuracy solutions in the healthcare payer space.  Experience leading sales teams is required as is extensive experience calling on and selling to Health Plan “C” level executives, SVP Business Owners, procurement, VPs and directors is essential.  Experience working in a leading Health Plan software and service vendor selling Payment Accuracy solutions including claim editing, data mining, coordination of benefits, clinical chart validation and/or fraud, waste and abuse detection is also key.  We are looking for candidates...

The staff accountant reports to the Director of Accounting and is responsible for preparing journal entries, account reconciliations and other activities associated with the monthly general ledger close and preparing balance sheet and income statement variance analysis.

The Data Scientist II - 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 of the most pressing healthcare issues of our time. A Data Scientist at Cotiviti will be given the opportunity to work directly with a team of healthcare professionals including analysts, clinicians, coding specialists, auditors and innovators to...

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...

The Program Manager, Operations will partner directly with the assigned Client Executive and will focus on the execution and delivery of the Cotiviti HEDIS/Quality Products and Services. The Program Manager will directly own and manage a small number of clients and is responsible to oversee all aspects of our engagement for our HEDIS/Quality solution set. The Program Manager will leverage their healthcare and project management knowledge in an effort to deliver the highest quality of services to Cotiviti clients.

The QA I, Clinical Ops position works with the Coding & Clinical Validation Audit team focused on risk coding. The QA position monitors & reports on the accuracy of all code captures on a % of all images of their assigned coders. This position also answers all questions for their coders through the Questions Queue or via email. QA is also responsible for assisting in the remediation for their coders which include full image review of all images coded prior to release to ensure accuracy of image, for any coder below project benchmark.   We are currently looking for multiple Remote Risk Adjustment / HCC Coders for full-time...

The Sr. Software Engineer is primarily responsible for the design and development of software 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.

The Client Retention Director is a role within the Go-To-Market team dedicated to partnering with Cotiviti’s internal Sales, Client Engagement, and the /business unit to successfully renew strategic or named clients with favorable terms and conditions. The Client Retention Director is responsible for independently leading assigned deals and working as a member of a collaborative team. The role will be responsible for proactive management of the renewal schedule for assigned clients working with the business units, Legal, and Finance. This role will prepare internal renewal strategy materials, facilitate client-ready...

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.

In partnership with client-facing teams, the Client Enablement Manager serves as an intermediary between clients and development, with a focus on client-centric project management, troubleshooting and escalation. This role will also

The Business Intelligence Developer collaborates with various team members and operational departments to develop internal and external reporting tools and gather/analyze requirements using industry best practices. They will work extensively in both ad-hoc and standard reporting packages and be involved in creating reports and dashboards that are scalable with large volumes of data.

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 Developer will work with core applications and database in the Payment Policy Management platform to help build and deliver features as a part of the team using SAFe practices. The...

The Data Integration Specialist will analyze, develop and enhance all new and existing interfaces for claim batch file and real-time data integration. The person in this role will serve as a subject matter expert for healthcare claims analysis utilizing both technical expertise and business insight. This role provides analytical support to internal and external customers on various projects, conducts detailed claims analysis and ad-hoc reporting as prioritized by management. This person in this role will spend time working independently, as part of a broader team, and will focus on...

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 preparing and submitting check request to corporate finance, processing electronic requests in multiple systems and platforms, and preparing and submitting spreadsheets to our clients. 

Cotiviti is looking for an enthusiastic and dedicated Client Executive (CE) who is motivated to support the transformation and improvement of our nation’s healthcare system through the use of healthcare analytics and consumer engagement. The CE role is a critical, client-advocate position with both internal- and external-facing responsibilities. The CE is assigned ownership of an existing set of accounts and is responsible for understanding how the client is using our solutions and helping them maximize the potential of our tools....

Strategic Vendor Solutions ("SVS") provides support services to the entire Cotiviti, Inc. ("Cotiviti") organization for the contracting of vendors who provide products and services to Cotiviti as well as any vendors with potential to join Cotiviti's mission through a joint venture, product development or some other form of strategic partnership.   Cotiviti is a leader in analytics driven healthcare payment accuracy and quality-based solutions with locations in the USA, Canada, Australia, Nepal and India and relies heavily on leading edge technology to deliver these products and services to our wide range of customers. SVS is tasked with...

Cotiviti is looking for an enthusiastic and dedicated Client Executive (CE) who is motivated to support the transformation and improvement of our nation’s healthcare system through the use of healthcare analytics and consumer engagement. The CE role is a critical, client-advocate position with both internal- and external-facing responsibilities. The CE is assigned ownership of an existing set of accounts and is responsible for understanding how the client is using our solutions and helping them maximize the potential of our tools....

The VP, Product Development will lead a matrixed team to prioritize and deliver new solutions to the market. This role will define and lead Cotiviti’s strategy to deliver new payment integrity solutions leveraging our leading industry position and expertise to focus. This individual will have responsibility for leading a team and personally understanding and prioritizing market needs, performing competitive analysis, engaging experts within and outside our organization, defining solutions for new market needs, and leading delivery and product launches for new offerings.  

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 Sr Software Engineer is primarily responsible for the support of the existing software applications and enhance software components deployed in the Cotiviti product suite. The successful candidate will be required to collaborate effectively with senior developers, offshore development team members,...

The Senior Software Engineer - Full Stackwill work with core applications and database in the Payment Policy Management platform to help build and deliver features as a part of the team using SAFe practices. The developer will need to have strong healthcare background and be familiar with the domain. The developer will be focusing on one or more specific initiatives with the team. The developer will be responsible for implementing features for upcoming new initiatives while also making recommendations and improving the existing code base.   The developer...

The Technical Project Manager will be responsible for leading Infrastructure-related projects as well as assisting teams to complete day-to-day

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.

Daily, substantial contact with internal management and executives. Frequent contact with clients, providers, and business partners.

Cotiviti Retail audits purchases and payments related to merchandise inventories. We develop and prioritize an audit program to ensure value negotiated is value delivered, recommending actionable process improvements that help our clients improve the way they do business and mitigate financial loss from overpayments and under-deductions.    Too often, audits, contract reviews, and recovery efforts focus on one aspect of a retailer’s operations without considering how the business works as a whole. Cotiviti Retail works smarter and digs deeper, looking at a business from all angles to find sources of profit in unexpected places....

This is a technical role within Cotiviti’s IT Organization for a Jira and Confluence Architect. The ideal candidate will have a proven track record in designing, implementing, and managing Jira and Confluence Data Center products to meet complex business requirements. This role requires strong architectural expertise, hands-on experience, and the ability to optimize Atlassian products and secure Jira and Confluence environments.

The Sr BI Administrator will be responsible for working in the Cotiviti Infrastructure team. We are in search of a proficient Senior Power BI/ Microsoft Fabric Engineer/Developer with expertise not only in developing insightful dashboards and reports but also in administering Power BI and Microsoft Fabric environments. In this role, you will play a pivotal part in managing the technical and security aspects of these environments while ensuring optimal utilization. You will provide guidance on best practices for utilizing these tools, facilitate user training sessions, and oversee integrations with other systems.

A Product Manager is a key role within an assigned business unit that is responsible for the development, strategy, and performance of a specific product or product line. Plays a critical role in driving the success of a product by defining its vision, strategy, and execution plan, and collaborating with cross-functional teams to bring it to life.   Successful Product Managers possess a combination of technical expertise, analytical acumen, communication skills, leadership abilities, customer focus, strategic thinking, and collaboration skills. They play a critical role in driving the success of a product and delivering...

The Senior Technical Specialist role is aligned to our Content and Enablement team supporting the RCA Business Unit. This role will partner will various divisions and levels of leadership within the whole organization.   The Senior Technical Specialist role will be responsible for working with Product Owners and Technical Architects to define project scope, technical direction, and project milestones. You will have responsibility for working with other stakeholders to define business requirements, acceptance criteria and non-functional requirement consistent with SAFe (Scaled Agile Framework). You will also...

The Coordination of Benefits (COB) & Data Mining (DM) Audit Support is a member of the greater Coordination of Benefits and Data Mining Business Units (BUs.) This individual will efficiently and professionally handle daily administrative activities within the COB and DM departments to assist the audit to meet and exceed client expectations. This role requires exceptional verbal communication by audio as well as attentive attention to detail for data entry-related written communication and follow–ups for both internal and external client inquiries to achieve success in the generation of overpayments.

As a Technical Specialist at Cotiviti, you will engage in tasks typically associated with Data Integration Specialists/Analysts and ETL Developers. Your focus will be on supporting the design and implementation of data transformation processes that are critical to achieving our strategic business objectives. While you will collaborate with stakeholders to understand business requirements, acceptance criteria, and non-functional requirements in alignment with the SAFe (Scaled Agile Framework), your primary responsibility will be the hands-on execution of these requirements. This places you directly in the flow of transforming insights into action, ensuring that our data processes align with and support our overarching business...