The Senior Manager of Clinical Services will be responsible for driving operational efficiency, product quality, clinical review optimization and alignment to meet client needs for HEDIS, STAR and other health measure chart review and abstraction related services. This role will closely partner with Program and Product Management teams to prioritize innovation and support our market and customer needs.   HEDIS® is a registered trademark of NCQA.

The Sr. Technical Product Owner is responsible for driving solution design and definition that support business ideas and product concepts at a team, program, and enterprise level through ideating, gathering, refining and translating product vision and requirements into application software solutions. The Sr. Technical Product Owner has deep domain knowledge, and strong experience in collaborating with a diverse cross-functional team including Product Managers, Solution and Enterprise Architects, User Experience Designers, and teams such as Client Services, Operations, Clinical, Data Science, and Marketing. Sr. Technical Product Owner’s are accountable to facilitate and drive Design Driven...

The purpose of the MIPS (Medical Image Processing) Agent is to review and associate medical records to the appropriate requests while maintaining adequate production and quality levels through tracked metrics.   This is a REMOTE Position and TEMPORARY for 4 months.  The schedule may require a Tuesday through Saturday commitment. 

The Senior Software Engineer is responsible for the design and development of software applications and reusable software components for the Cotiviti, Inc. (Retail) product suite, in compliance with predefined coding standards and technical design. You will be required to collaborate effectively with senior developers, QA, product owners, project management, and other internal stakeholders.   This is a hands-on technical role to support our Retail audit team through client data conversion and the support, development, and delivery of audit tools and reports. Ideal candidate combines experience with Microsoft Access application development...

We are seeking a passionate, talented, and enthusiastic AI Product Manager 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.

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 Principal Technical Product Manager is the liaison between Product Management and software development.  This role works with Product Management, business stakeholders, and architecture to understand current and future needs related to the acquisition of medical records in support of Cotiviti’s products, the Epics that represent required development work, and to formulate and maintain the technical roadmap that lays out the delivery path for Epics, Features, and functional and enablement Stories.  The Principal Technical Product Manager is versed in the software development life cycle, technology integration, and technology trends as related to software development, and uses this...

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.

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.    

The Product Manager, within our Clinical Chart Validation team, will be responsible for leading technology product roadmaps supporting key operational processes as the business lead working closely with a wide group of stakeholders for solution design and delivery. This position will lead other operational activities on an as needed basis.

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.

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.

The Senior Quality Analyst tests web applications and software to ensure standards are met by reviewing requirements, specifications, and technical design documentation, identifying risks to system functionality, creating test plans, and executing test cases. This role requires someone who can take the lead in ensuring the quality and reliability of our products, maintaining high standards, and continuously seeking ways to improve our processes.

The Site Reliability Engineer (SRE) is responsible for leading the continuous evolution of the capabilities needed to ensure the reliable delivery and operation of the software solutions which enable Cotiviti’s ability to retrieve medical records from healthcare providers.   The SRE works closely with architects, development teams, production operations, and product owners to enable the appropriate level of reliability to meet business objectives.  The SRE serves as a mentor and...

A GTM role dedicated to supporting Sales, Client Engagement, and the Business Unit to successfully renew strategic clients with favorable terms and conditions. The candidate should demonstrably possess the skill and experience to work as a member of a collaborative client leadership team and to be responsible for proactive management of the renewal schedule, creation of and sharing of best practices across all segments, acting as the business unit liaison, legal planning and liaison, and proactive leadership...

The Senior Technical Program Manager is tasked with driving large, cross-discipline, company-wide projects with high executive visibility. These projects include post-merger integrations, international operations, systems implementations, and other projects as directed. As each project is different, the project manager must use a variety of tools, approaches, and formal methodologies to successfully complete the objectives including a deep understanding of the SAFe Framework. This position is strongly self-driven, with the program manager given an end goal and responsible for independently driving the initiative to success while interacting with a large variety of independent teams and separate...

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.

As the DCO Director you will be responsible for the management, strategy, and execution of Datacenter infrastructure for Cotiviti. You will be overseeing technical projects in alignment with organizational goals and coaching direct reports within the organization. Directing the effective delivery of rack, space, cabling, power, capacity of the datacenters, and corporate offices IDF / MDF closets as well as processes.

The Data Architect implements and governs technical data architecture development and provides architectural leadership and guidance to align IT solutions and the development organization with the needs of Cotiviti’s Retrieval Operations and the products which it supports.  The Data Architect’s skills and knowledge must span the Retrieval domain and include all AWS technologies currently used, as well as those which could potentially be used by Cotiviti to enhance its Retrieval platform.  The Data Architect must be an expert in data life cycle management from discovery through implementation.  Responsible for architecting and implementing (hands on) scalable data...

The System Architect implements and governs technical architecture development and provides architectural leadership and guidance to align IT solutions and the development organization with the needs of Cotiviti’s Retrieval Operations and the products which it supports.  The System Architect’s skills and knowledge must span the Retrieval domain and include all AWS technologies currently used, as well as those which could potentially be used by Cotiviti to enhance its Retrieval platform.  The System Architect must be an expert in architecting and implementing cloud native AWS solutions incorporating NestJS and Terraform.  The System Architect is expected to...

A Payment Accuracy 2, Data Mining (DM) Specialist, is a member of the greater Data Mining Business Unit (BU). Cotiviti's Data Mining team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types.   The Specialist 2, Payment Accuracy is responsible for developing new and existing audit concepts, gaining client acceptance, training all Specialist levels to execute audit projects, and evaluating the effectiveness of audit concepts.  Audits client data and generates high quality recoverable claims for...

The Sr 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 Sr 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 Sr Program Manager, Operations will leverage their deep healthcare and project management knowledge to deliver the highest quality of services to Cotiviti clients.

At Cotiviti, we are custodians of data for our clients. Using their technical experience in ETL processes, Data Engineers ensure operational functions are occurring as expected. This includes but is not limited to managing data implementations, data integrations, data production, data quality, and data security.

The Yield Support team works to facilitate daily administrative activities efficiently and professionally within the department and business unit by assisting with elements our Data Mining (DM) /Coordination of Benefits (COB) Specialists, Recovery Operations, Revenue Cycle, and Inventory Management Specialists teams, to achieve success as an overall organization. This team will also work with the greater leadership team to improve and manage our business optimizations as well as meet and exceed our goals and deliver exceptional customer expectations both internally and externally.   As a Yield Support Specialist this role is under direct...

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.

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...

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 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...

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,...

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.

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...

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 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 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.

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...

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...

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,...

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.