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.

The Technical QA Analyst is knowledgeable in both the configuration and testing of our cloud based omni and multi-channel healthcare engagement solutions and responsible for their release into our production environment. This is done through proprietary tools that are integrated with Amazon Web Services, third party vendors, and conventional code languages. This role is responsible for contributing towards the daily release of omni-channel solutions implementations per the client agreed scheduled dates and times, by partnering with multiple teams across the enterprise to ensure...

The Senior Solution Architect is responsible for creating best-in-class business offerings. This is accomplished through collaboration with business leaders, sales and support teams, and client conversations. The Senior Solution Architect will have responsibility for establishing and sustaining processes and practices that support present and future sales and implementations, ensuring sales are aligned with current technical offering and capabilities, and that custom client requests are substantiated and well understood. The Senior Solution Architect should have a passion for helping others understand our technical solutions and architecture, creating well defined...

Cotiviti is currently looking to add an industry leading Data Scientist I - ML, 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,...

We are looking for an Recovery Resolution Specialist 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.

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.

The Implementation Consultant assists in the testing and implementation of Cotiviti’s 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 Consultant/Architect and may do so either at our offices or at client sites. This includes installation of products on client hardware; configuration and development of programs, tasks and guidelines, and setup to fully implement a Cotiviti solution. Duties can range from delivering product training to new client specific requirements, development and deployment. The role involves client coordination...

The Director, Audit Operations (Contract Compliance Recovery Audit) position is responsible for providing leadership and management for our vast and expanding global client base. Oversee the existing and expanding team in the delivery of all contract review and financial audit activities for assigned accounts to maximize team performance, ensure our client’s service providers are fulfilling their contractual obligations, achieve internal and client financial and operations objectives, and deliver customer satisfaction consistent with established operating practices and audit procedures. This will be accomplished through effective audit operations management, quality and service assurance, and effective people...

The Vice President of Audit Operations (Contract Compliance Recovery Audit) will lead and grow our global contract compliance practice within both the retail and commercial sectors. This role involves not only managing the current business unit but also collaborating with the sales department to identify and secure new clients and service opportunities. The ideal candidate will be adept at managing a contract compliance recovery audit business unit with a focus on profitable growth, resource optimization, talent development, market trend analysis, and industry engagement.   The Vice President will provide leadership and management for our...

The Data Scientist II - AI/ML 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 set...

The Integration Solutions Engineer Level II will play a key role in building and supporting integration solutions within the company’s software ecosystem. This role requires close collaboration with clients, business teams, developers, and infrastructure providers to design and implement scalable, high-quality integrations that meet business needs. As a senior technical contributor, you will also mentor junior engineers, develop best practices, and ensure that integration processes are efficient, reliable, and aligned with the company’s goals. Additionally, you'll...

Cotiviti is seeking a Senior Operations Engineer to join our Engineering Team. The Senior Operations Engineer works primarily with enterprise customers of Cotiviti products, proactively assisting them with post- sales installation, configuration, upgrade, troubleshooting and day to day operational management. Responsibilities include leading the Engineering team and Customers to address complex technical and application issues affecting product performance and customer adoption of Cotiviti products. The Senior Operations Engineer will collaborate with Development, Sustaining Engineering, and Sales Engineering teams to resolve support...

The Sr. Implementation Program Manager will be responsible for managing and coordinating multiple implementation projects across various product lines within Cotiviti. This role will serve as the primary liaison between the Customer teams and the Cotiviti teams including implementation/delivery, Product and other relevant teams as necessary, ensuring that products/solutions delivered align with agreed upon Customer requirements and the intended business outcomes. The successful candidate will also be responsible for capturing Customer feedback, understanding the reasons behind any gaps, and managing the process to triage and resolve these gaps. The candidate will also support the internal...

The intern will assist in working on new ideas submitted to the Innovation Lab with project management ideologies. Will work on identified tasks and backlog of innovation opportunities alongside other team members. Candidates should have an interest in project/program management, innovation, and process improvement to deliver business value. We are looking for skills in the Microsoft Office suite. Some practical experience with SmartSheet would be preferred. This will be a great learning opportunity to pick up project management skills while helping to solve and manage health business...

The Clinical Consultant support Clinical Services teams in the validation of quality and processes consistency on the Claims Processing Editing Engine (CPE).     Provides support and subject matter expertise on Coding Validation (CV) to both clients and internal stakeholders during the planning, implementation, go-live, transition to operational team, and through the duration of the contract. Clearly understands and articulates CV concepts and policies. Collaborates with internal teams to provide meaningful...

The Delivery/Project Manager-Public Sector will be responsible for managing and coordinating multiple implementation projects within Cotiviti. This role will serve as the primary liaison between the Customer teams and the Cotiviti teams including implementation/delivery, Product and other relevant teams as necessary, ensuring that products/solutions delivered align with agreed upon Customer requirements and scope. The successful candidate will also be responsible for capturing Customer feedback, understanding the reasons behind any gaps, and managing the process to triage and resolve these gaps. The candidate will also support the internal delivery teams from program coordination,...

Join the Cotiviti Security team and be at the forefront of protecting our cutting-edge hybrid cloud infrastructure and applications! We're on the lookout for a dynamic Principal Cloud Security Engineer to elevate our security game. In this exciting new role, you'll be the driving force behind integrating top-notch security practices into our DevOps pipeline, ensuring our applications and infrastructure are secure, compliant, and rock-solid. If you have a passion for DevSecOps and a deep understanding of security principles, DevOps practices, and frameworks like NIST 800-53, we want you on our team!

Cotiviti is looking for a candidate to join our team as a Regional Vice President, Healthcare Payer Sales. This is a direct sales position with quota responsibility. The ideal candidate will be an articulate, high-energy, self-motivated sales professional with a minimum of 10 years’ experience selling enterprise software solutions to the health insurance industry. If a candidate has experience selling B2B, middleware, data transformation solutions, business intelligence software, or value- based care that’s a plus. The Regional Vice President, Payer Sales will be responsible for managing all Health Care...

This is a hunter role in the healthcare payer space. 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 in the Payment Integrity space is required with specific experience selling Coordination of Benefits and/or Data Mining solutions being highly desired. We are looking for candidates across the US.

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 Sr. Support 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 other developers, offshore development team members, business owners, project management, and other internal stakeholders.

Cotiviti is hiring a Product Analyst to join our dynamic products team. As a Product Analyst, you will play a crucial role in guiding our products from conception through launch and beyond, managing the entire product lifecycle. You will be instrumental in integrating our new product with various partner products. Your expertise will be key to ensuring seamless integration, particularly in the realm of claims management and standard EDI...

The Sr. Support 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 other developers, offshore development team members, business owners, project management, and other internal stakeholders.

The Investigator will work as part of a team responsible for investigating Healthcare Fraud, Waste or Abuse. This position partners with more senior investigators and will focus on both analyzing healthcare data, identifying potential FWA, and conducting interviews. This position can be done remote, from your home, in the continental United States.

Provides day-to-day supervision and direction to assigned audit team. Ensures operations are running optimally and processes and procedures are being followed. Ensure appropriate staffing levels, and plan and organize workloads and staff assignments according to the needs of the audit. Manages the overall performance, productivity and quality assurance of the assigned audit team. Maximizes opportunities of the audit; optimizes timely audit processes and efficiencies. Involved in formulating all budget related aspects of the audit. Executes and adjusts to budget demands. Drives the profitability of the audit engagement.

We are looking for a full-time Senior Accountant to join our Financial Reporting team. This role is responsible for assisting with the financial reporting function of the organization. Primary responsibilities include the preparation of financial statements and footnotes in accordance with GAAP, leading the monthly trend analysis, and preparing technical accounting memos. This role will be working cross-functionally with various departments which will primarily include General Accounting, Research and Development, and FP&A. This role will be reporting to the Director, Accounting - Financial Reporting and Investor Relations.

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...

The Product Director will drive strategy for Cotiviti’s Payment Integrity Client platform product roadmap. This individual will have responsibility and leadership for understanding and prioritizing market needs, performing competitive analysis, performing product discovery, supporting design, delivering business cases and leading delivery and commercial product launches for new products and capabilities

We are seeking a developer to join our dynamic team. The developer will be responsible for designing, developing, and maintaining software applications using Microsoft Power Platform. The ideal candidate will have experience with all of these Microsoft technologies: Power Apps, Power Automate, AI Builder, Azure AI Studio, Co-Pilot and DataVerse as well as proficiency in one other language, such as Python.

We are seeking a senior developer to join our dynamic team. The developer will be responsible for designing, developing, and maintaining software applications using Microsoft Power Platform. The ideal candidate will have significant working experience with all of these Microsoft technologies: Power Apps, Power Automate, AI Builder, Azure AI Studio, Co-Pilot and DataVerse as well as proficiency in one other language, such as Python.

We are a Healthcare Data Analytics company looking for a Sr Manager of Engineering. In this role you will lead, direct, and manage the day-to-day operations of software engineers and TPOs. You will work closely with other R&D teams, enterprise data management teams, IT, and Client Services teams, as well as the Clinical operations teams. You will manage all the operational aspects of the software development to ensure business and project objectives are met and delivered on time. You will provide administrative, technical, and people leadership for multiple, diverse, and geographically distributed teams. You are responsible for providing feedback to the team and individuals on their performance....

We are seeking 4 interns to work on low-code development projects on our dynamic team. The interns will be responsible for designing, developing, and maintaining software applications using Microsoft Power Platform. The ideal candidates will have experience with some of these Microsoft technologies: Power Apps, Power Automate, AI Builder, Azure AI Studio, Co-Pilot and DataVerse as well as proficiency in one other language, such as Python. Two of the four positions could potentially lead to a full-time position upon completion of the internship.

Under the direction of the Vice President of Interoperability, the Business Development Associate, Interoperability will be a key team member in Cotiviti’s strategy for acquiring electronic health data. This individual will be responsible for contacting healthcare providers, identifying decision makers, and conducting business development meetings to accelerate Cotiviti’s acquisition of digital health data. Success in this role is the ability to influence providers or health systems to move from manual record retrieval workflow to a fully automated, digital process.  

The Program Manager, Operations will partner directly with the assigned Client Executive, retrieval, coding, and reporting team leads and will focus on the execution and delivery of the Cotiviti Risk Adjustment Products and Services for enterprise-level accounts. The Program Manager, Operations will directly own assigned accounts and is responsible for overseeing all aspects of our engagement for our Risk Adjustment solution set. The Program Manager, Operations will leverage their deep healthcare and project management knowledge to deliver the highest quality of services to Cotiviti...

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)....

The Senior Accountant, Revenue Accounting, will participate in a wide variety of tasks including month-end, quarter-end and year-end closing processes, including analyzing and preparing Journal entries, reconciliations and other workpapers and analyses. He/she will also assist in the documentation and compliance of procedures and controls.   This position reports to the Manager, Revenue Accounting.

The Content Solutions Analyst I 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.   While this team has several areas of expertise, we will be looking to fill this role with a nurse/coder with inpatient DRG experience. 

We are 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 contributing to improving our retail clients’ profitability and want to be part of a team that provides opportunities for career growth. If you want to make a difference and contribute to the service we provide our Retail clients, consider an opportunity to join our global retail recovery team as an Auditor.   The critical function of a Contract Compliance Auditor I is to audit billings from our clients’ suppliers in...

We are 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 contributing to improving our retail clients’ profitability and want to be part of a team that provides opportunities for career growth. If you want to make a difference and contribute to the service we provide our Retail clients, consider an opportunity to join our global retail recovery team as an Auditor II.   The critical function of a Contract Compliance Auditor II is to audit billings...

The Integration Solutions Engineer will play a key role in building and supporting integration solutions within the company’s software ecosystem. This role requires close collaboration with clients, business teams, developers, and infrastructure providers to design and implement scalable, high-quality integrations that meet business needs. Additionally, you'll have the opportunity to research emerging technologies, enhance integration capabilities and driving innovation.

The Product Director will drive and own product management functions and the commercialization of products to our partners, working with our internal groups in marketing, sales, and operations.   This individual will have responsibility and leadership for commercial presentation material for existing retail solutions. This role will work with the product team to deliver innovation and revenue growth for new elements of Cotiviti’s retail payment accuracy portfolio including direct ownership of one or more retail products.   

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.

As a Senior Database Admin, you will help drive team(s) in meeting project objectives. You are expected to contribute to and foster high performing technical teams. You will also be responsible for the design and coding of complex DB systems. You will collaborate and communicate effectively with architects, engineers, QA, DBAs, and Business managers to solve complex problems spanning their respective areas and resolving technological disagreements with informed,...

The Senior Director, Product Management will lead a matrixed team to drive commercial market success for Cotiviti’s payment integrity offerings. This role will lead the definition and execution of Cotiviti’s market strategy for client solutions including Data Mining (DM), Contract Compliance (CC) and Coordination of Benefits (COB). This individual will understand and prioritize market needs, perform competitive analysis, engage experts within and outside our organization, lead client Product Advisory Boards, define solutions for new market needs, and lead delivery and product launches to expand our client value proposition and advance Cotiviti’s market position.  

In the role of Concept Development Analyst within our Clinical Chart Validation organization, you will lead in the identification, creation, and implementation of innovative concepts within the healthcare billing and coding field. Drawing from your industry experience and knowledge of clinical practices and regulations, you will assist in the development of novel strategies to enhance our claim selection processes. Your proficiency in data analysis,...

This is a hunter role in the healthcare payer space. 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 in the Payment, Analytics or Population Health industry is also key. We are looking for candidates across the US.

The Medical Director (MD) is a key member of the audit, quality assurance and client team. The Medical Director is responsible for representing the team on all audit and appeals decisions. The Medical Director is also responsible for analyzing, interpreting, and developing additional policies that will allow us to enhance our medical policy library. The Medical Director will guide both internal and external processes as related to CCV inpatient audit, documentation, and communication of results.

The Principal Data Scientist Risk 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 Principal AI Scientist - 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 Director AI - Risk & Responsible 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. The opportunity includes to to work directly with a team of healthcare professionals including analysts, clinicians, coding specialists, auditors and innovators to...