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 Technical Product Owner is responsible for driving solution definitions that support business ideas and product concepts at a team and program level through gathering and translating testable requirements into application software solutions. The Business Analyst has deep domain knowledge, and strong experience in collaborating with a diverse team including product managers, software developers, testers, and teams such as Client Services, Operations, Clinical, Data Science, and Marketing.

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 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 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.

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.

In accordance with contractual requirements, the Program Manager will partner with the assigned account management team(s) in support of the successful delivery of Cotiviti Government Services client(s). Responsibilities include supporting the implementation and on-going execution of government contract(s), maintaining an excellent client relationship, and creating value for the client by identifying contract growth opportunities. The Program Manager will collaborate with the account management team on financial, operational and business decisions in support of the client contract. A successful candidate should possess strong analytical, organizational, and self- management skills.

Cotiviti drives better healthcare outcomes through data analytics. Our payment accuracy, revenue integrity, risk assessment and stratification, and quality improvement solutions help organizations utilize their data so they can efficiently and cost-effectively succeed in the new era of healthcare.   We are currently looking for multiple Remote Risk Adjustment / HCC Coders (Coder 2) for full-time permanent positions. See what it's like to work as a Coder at Cotiviti:

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.

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...

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.

Cotiviti is looking for a motivated and creative Marketing intern to join our dynamic and innovative team for summer 2025, where you can gain valuable experience in the healthcare technology sector. As a Marketing intern, you will have the opportunity to rotate across the different areas of Marketing including: content and communications, strategic conferences and events, public relations & social media, product marketing, operations, performance and analytics, along with creative services. You will work closely with our Marketing leaders...

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....

A Payment Accuracy 1, 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 Payment Accuracy 1, Data Mining (DM) Specialist is responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients.  Responsible for conducting or assisting in the identification, validation, and documentation of moderate to more complex...

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 Cotivti’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 RegulatoryAttorney supports the VP,Associate General Counselon advising on a wide range of...

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...

We are seeking an experienced and visionary vice president of data ingestion engineering to lead our engineering team and be responsible for one of the most critical products in our portfolio. Our data ingestion is a sophisticated data ingestion solution within the Cloudera ecosystem, responsible for processing 50% of the medical claims in the country. This role demands a leader with deep technical expertise in big...

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...

As a Business Development Representative (“BDR”), you will support the growth of the sales pipeline and expand target account intelligence for Cotiviti. The BDR frequently is the voice of Cotiviti, which sets the tone of the customer experience, particularly in first-contact situations. You will support the management of sales territories by establishing relationships, conducting introductory conversations, and gathering intelligence that enables Cotiviti to favorably compete for the prospects’ business. BDRs support analysis and reporting needs of sales operations by developing business profiles of targeted accounts, also referred to as “New Logos.” BDRs also support marketing program development by...

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 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 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. 

The Program Manager, Operations will partner directly with the assigned Program Manager, Operations and Program Director in support of a strategic client account. Responsibilities focus on the execution and delivery of the Cotiviti HEDIS/Quality Products and Services. The Program Manager is dedicated to support and manage the strategic client’s account, while being responsible for oversight of all aspects of their medical record retrieval project. The Program Manager will leverage their deep healthcare and project management knowledge to deliver the highest...

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 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 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...

The Sr Data Scientist - Generative AI II will apply knowledge and expertise to real world problems to enable healthcare organizations to deliver better care at lower cost through advanced technology and data analytics, helping to ensure the quality and sustainability of how healthcare is delivered in the United States. With access to dedicated on premise and cloud based big data solutions, the team can work with a vast amount of structured and unstructured data including claims, membership, physician demographics, medical records and others to begin to solve some of the most pressing healthcare issues of our time. A Data Scientist at Cotiviti will be given the opportunity to work directly...

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.

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 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...

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...