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This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits. The ideal candidate for this position needs to have a coding/auditing background focused on Inpatient DRG Coding from a coding and billing perspective. This position is responsible for auditing inpatient DRG and documenting the results of those audits with a focus on coding accuracy and the appropriateness of treatment setting and services delivered.
This role...
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The Support Analyst will assist in monitoring, analyzing, and resolving data platforms, configuration, and infrastructure-related issues. This person serves as a lia
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The Data & Insights Analyst is responsible for leading the design, architecture, and delivery of advanced analytics, reporting, and data-driven solutions that generate measurable business value. This role operates as a strategic partner to business and technical stakeholders, translating complex data into actionable insights and scalable solutions. The Analyst plays a key role in shaping data strategy, advancing modern data platforms (including cloud and big data ecosystems), and embedding AI/ML capabilities into analytics workflows. This individual is expected to influence best practices, and drive innovation across the Analytics function. This role requires a balance of hands-on technical expertise, business...
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The focus of the VP, Client Engagement is to develop and execute against growth, renewal and retention strategies on their customers within the top customer tier. The VP Client Engagement is accountable for the coordination and transparency needed to drive a successful, multi-pronged growth and retention strategy as well as a multi-level relationship engagement across the customer leadership team.
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Join a recently formed team focused on Model Risk and Responsible AI. The Senior GenAI Scientist II – Risk will apply knowledge and experience to real world problems and seek to utilize their skills to reduce the cost of healthcare and improve health quality and outcomes. As a Data Scientist on this team, you will focus on three main project areas: Model Validation, Model Metrics and Monitoring, and Responsible AI. This requires someone with depth in
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Join a recently formed team focused on Model Risk and Responsible AI. The Generative AI Scientist - Risk will apply knowledge and experience to real world problems and seek to utilize their skills to reduce the cost of healthcare and improve health quality and outcomes. As a Data Scientist on this team, you will focus on three main project areas: Model Validation, Model Metrics and Monitoring, and Responsible AI. This requires someone with depth in AI/ML/GenAI from a data...
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Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Payment Accuracy Specialist 2.
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The Client Medical Director (CMD) is a key member of the Go To Market team. Along with the Client Engagement Leader, the CMD co-captains the team serving the Prospective Payment Management (PPM) client team at the health plan. The CMDs role is to serve as a coding and medical payment policy subject matter expert (SME). The CMD is responsible for directing the Medical Policy Committee (joint committee with health plan MD, coding experts, and payment integrity). The CMD will develop a relationship with the client, review their data, select medical policy to present, serve as SME for clinical and coding expertise, and back end support for the client’s Medical Director. The CMD will evolve as the trusted advisor for the Health Plan...
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The Product Manager – Fraud, Waste, and Abuse (FWA) is responsible for driving the strategy, development, and lifecycle management of Cotiviti’s FWA product suite, including advanced analytics-driven solutions designed to identify and prevent improper healthcare billing. This role works at the intersection of product, analytics, operations, and client engagement to deliver high-impact solutions that improve payment integrity outcomes for healthcare payers.
The Product Manager partners closely with cross-functional teams including R&D, data science, operations, implementations, and...
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This DRG Validation Auditor role is focused on our Cross Claim Clinical Reviews (CCCR). Auditors in this role will be doing DRG Validation for our prepay and retrospective audits and making determinations without a medical record. The ideal candidate for this position needs to have both a strong inpatient HIM/coding background and an understanding of clinical validation. 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...
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The Drug and Biological Policy (D&B) Content Analyst II is a key member of the clinical operations and content team and is responsible for the research, quality assurance, and maintenance of existing D&B policies. This individual is expected to define additional logic and algorithms to expand the D&B Library and add value for our clients who implement this policy.
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We are looking for an Recovery Resolution Specialist (Collections) 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.
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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.
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This auditing role will focus on Coding & Clinical Chart Validation for our Outpatient and Specialty audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on one of the following disciplines from a coding and billing perspective: SNF, IRF, Home Health, APC, ER, Diagnostics and Professional Service. This position is responsible for auditing outpatient/specialty claims and documenting the results of those audits. with a focus on clinical review, coding accuracy, medical necessity, and the appropriateness of treatment setting, and services delivered.
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The Coding Manager leads a team of coders, directly or indirectly, to deliver key components to the Cotiviti coding program. This role works with the Director of Coding, the Client team and other areas related to production, QA, and analytics for oversight of ongoing production and quality accuracy.
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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...
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Cotiviti is a leading analytics and technology company in the healthcare industry, providing solutions that help health plans and providers improve payment accuracy, risk adjustment, quality, and clinical outcomes. Our payment accuracy platform processes over $800 billion in claims annually, serving more than 30 of the top health plans in the United States.
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Cotiviti works with more than 200 healthcare payers and health systems, including all of the top 25 plans in the United States, to deliver higher-performing payment accuracy, risk adjustment, quality improvement, and consumer engagement programs. We take in billions of clinical and financial data points, analyze them, and help our clients discover ways they can improve the efficiency and the quality of care.
The Implementation Director will guide the delivery of services and technology to one or more clients by planning, supporting, and managing implementation activities from...
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The Sr. Auditor, Quality Assurance position is responsible for ensuring that the audited claims meet quality standards necessary to generate high quality recoverable claims for the benefit of Cotiviti and our clients. Audited claim types include: Outpatient and Specialty Review Types to include SNF, IRF, HH, DME, Hospice and medical necessity. Quality assurance emphasizes compliance with established procedures, accuracy of claim identification and supportive documentation. Identifies and notifies management of observed quality and communicates opportunities for process improvements based on independent audit claims review. Displays professional...
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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.
This role aligns with our post-pay Fraud Waste & Abuse team.
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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.
This role aligns with our post-pay Fraud Waste & Abuse team.
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As a Medical Reviewer, you will be auditing medical records to evaluate the accuracy of medical coding and health plan policies for our Fraud, Waste & Abuse clients.
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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 up to 6 months.
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Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Payment Accuracy Specialist 2.
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The Public Relations Director leads Cotiviti’s external communications strategy, driving brand visibility, executive thought leadership, and market positioning across the healthcare ecosystem. This role owns Cotiviti’s public relations (PR) program, including media relations, earned media opportunities, executive thought leadership, press releases, speaking opportunities, social and digital media and awards program. This individual is responsible for developing and executing integrated PR programs that elevate Cotiviti’s reputation as a leader in healthcare...
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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....
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Technical Architect II designs and evolves intelligent workflow and automation solutions in an AI-native development environment. This role combines expertise in application architecture, workflow orchestration, and enterprise platforms with AI-assisted engineering tools (e.g., Claude, Copilot) to accelerate solution design, code generation, and SDLC execution.
The architect will support the Payment BU Workflow Intelligence & Orchestration Initiative, collaborating on client inquiry and payment workflows, while contributing to a Center of Excellence (CoE) for...
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A Senior Revenue Cycle Specialist is a member of the Revenue Cycle team within the Yield Management Division. This department may work directly with other members of Yield to ensure department expectations are accomplished. The Sr. Specialist, Revenue Cycle position is responsible for complex levels of recurring and/or daily functions and processes that are necessary for business execution; including but not limited to, ensuring the quality of various functions within the department (check application, offsets, invoicing,...
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Staff Engineer I (AI, Java) is a senior hands-on technical leader responsible for designing and building intelligent backend services and workflow-integrated solutions within an AI-native development environment. This role combines deep expertise in Java-based systems and workflow orchestration with AI-assisted engineering (Claude, Copilot) to enable scalable automation, intelligent routing, and decisioning.
The role partners with Technical Architects and leads engineering teams to deliver secure, scalable, and reusable services across enterprise workflow platforms.
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Senior Software Engineer (AI) is a hands-on role responsible for building intelligent backend services and workflow-integrated solutions within an AI-native development environment. This role combines strong Java-based engineering expertise with enterprise workflow orchestration to enable automation, intelligent routing, and AI-assisted decisioning. The engineer will support the Payment BU Workflow Intelligence & Orchestration Initiative, collaborating with Technical Architects and engineering teams to deliver scalable, secure, and reusable services across workflow platforms.
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The Senior Solutions Consultant serves as Cotiviti’s subject matter expert and “voice of product” for our consumer engagement solutions and broader Health Enablement offerings. This role partners closely with Sales, Product, and Client teams to pursue strategic opportunities, deliver compelling demonstrations, and provide deep expertise on member and provider engagement, intervention planning, and healthcare activation workflows.
The Senior Solutions Consultant bridges the gap between customer needs and...
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The Manager, Audit Content position is responsible for leading a team of Concept Development Analysts (CDA) and Operations Administrators in delivering value to Cotiviti’s operations and clients. This leader is responsible for oversight of their team, as well as participating in the development of new and existing complex audit concepts, executing audit projects, and updating concept policies based on changes in clinical and coding developments, statutes, regulations, and client policies.
The...
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Cotiviti is seeking a Director of Engineering to lead multiple software engineering teams within our Payment Integrity business. In this role, you will provide strategic and technical leadership across one or more product domains, leading through engineering managers and team leads to deliver high-quality, reliable software solutions.
You will champion an AI-native approach to software delivery by integrating AI...
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This is a highly visible senior strategic individual contributor role within Cotiviti’s National Accounts segment, with the opportunity to shape growth across some of the most important payer relationships in the market. The role is responsible for accelerating sales growth across Cotiviti’s full Healthcare portfolio by building executive relationships, advancing complex enterprise opportunities, and delivering strategic value to national health plans. Extensive experience and a demonstrated track record of selling enterprise solutions to Health Plan C-level executives, SVP business owners, procurement leaders, VPs, and directors are essential. We are seeking remote...
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We are seeking a highly experienced Principal Software Engineer to design and build the backend infrastructure for our centralized AI platform. This role will focus on developing robust, scalable backend services that power our agentic framework and enable teams across the company to securely deploy, manage, and access AI agents through unified APIs and user interfaces.
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The Medical Policy Director (MPD) is a key member of the Go To Market team. Along with the Client Engagement Leader, Client Medical Director (CMD), the MPD co-captains the team serving the Prospective Payment Management (PPM) client team at the health plan. The MPDs role is to serve as a coding and medical payment policy subject matter expert (SME), with the assistance of a CMD. The MPD is responsible for directing the Medical Policy Committee (joint committee with health plan MD, coding experts, and payment integrity). The MPD will develop a relationship with the client, review their data, select medical policy to present, serve as SME for clinical and coding expertise, and back-end support for...
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Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Senior Payment Accuracy Specialist.
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The Content Analyst II 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.
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The Strategic Pricing, Director is a member of the Corporate Development and Strategy team at Cotiviti. This person will be responsible for leading Cotiviti’s pricing strategy, including maintaining the company’s existing pricing and creating pricing models for new solutions. This person will...
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The Generative AI Developer Intern focuses on researching and developing advanced healthcare informatics, particularly in the realm of Generative AI and emerging Artificial General Intelligence. It is designed to support improvements in healthcare treatment, payment, and operations. The intern will assist and take a primary role in developing, researching, creating analytical materials, and collaborating with various teams to drive AI-related projects.
We are currently looking for interns who can start...
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The Senior Manager, Revenue Cycle Operations leads a team of Business Operations Analysts and Revenue Cycle Specialists supporting Cotiviti’s Clinical Chart Validation (CCV) operations and client delivery. This leader oversees revenue cycle management, month-end close activities, inventory management, client SLA delivery, and financial analysis for assigned clients within the Clinical Chart Validation business unit. The role is accountable for maximizing revenue recognition, minimizing financial leakage, strengthening process controls, and accelerating client savings value while serving as a trusted internal and client business partner. This position also supports workflow modernization through...
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The Corporate Development Associate is a member of the Corporate Development and Strategy team at Cotiviti. This person will be responsible for evaluating strategic acquisitions for Cotiviti, as well as supporting end-to-end M&A execution and corporate development initiatives across Cotiviti’s portfolio of products. This person will identify and evaluate new opportunities, conduct due...
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This role is expected to work Monday through Friday from 9:00 AM Pacific to 6:00 pm Pacific
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 production, data...
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The focus of the VP, Client Engagement is to develop and execute against growth, renewal and retention strategies on their customers within the top customer tier. The VP Client Engagement is accountable for the coordination and transparency needed to drive a successful, multi-pronged growth and retention strategy as well as a multi-level relationship engagement across the customer leadership team.
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Cotiviti is seeking a Director, Business Architecture to build and lead the Business Architecture capability for the Payment Integrity business unit. This role will define how the business needs to work to support scale, reduce fragmentation, improve business-to-technology alignment, and enable more efficient execution across the operating model.
This leader will clarify business capabilities, value streams, ownership, decision paths, and target-state operating models; identify redesign opportunities; and create the foundation for automation, AI enablement, innovation, and scalable transformation. The role requires a strategic leader who...
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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.
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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.
This role aligns with our pre-pay Fraud Waste & Abuse team.
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The Senior Counsel, Partnerships will be the main legal resource overseeing strategic partnership contracting. The role will also support the Director, Senior Corporate Counsel in overseeing the full life cycle of Cotiviti’s healthcare and non-healthcare vendor contracts – from initial negotiation through execution, ongoing management, renewal, and termination. This role will be responsible for reviewing, drafting, and negotiating a broad range of commercial agreements, including master services agreements, license agreements, SaaS agreements, business associate agreements, non-disclosure agreements, and other related commercial agreements. The ideal candidate will have...
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In the role of Concept Development Analyst (CDA) within our CCV business unit, you will support the enhancement and ongoing optimization of claim selection processes and tools, including AI-enabled methodologies. This role is primarily focused on applying deep clinical, coding, analytical, and reimbursement expertise to strengthen and operationalize existing selection strategies.
Leveraging your knowledge of inpatient billing, you will contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes. Your understanding of healthcare payment methodologies, coding behavior, and reimbursement rules...
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In the role of Concept Development Analyst (CDA) within our CCV business unit, you will support the enhancement and ongoing optimization of claim selection processes and tools, including AI-enabled methodologies. This role is primarily focused on applying deep clinical, coding, analytical, and reimbursement expertise to strengthen and operationalize existing selection strategies.
Leveraging your knowledge of inpatient billing, you will contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes. Your understanding of healthcare payment methodologies, coding behavior, and reimbursement...