Operations Administrator (OA) is responsible for daily support of functions across the CCV BU teams, including audit and client support to ensure that all processes are adhered to, metrics are met or exceeded, and documentation is created and maintained with high attention to quality and detail. The OA may flex to support various teams throughout the day, utilizing a variety of Cotiviti proprietary tools to complete tasks. OA may also access client data systems directly to validate claim information.
At Cotiviti, we are custodians of data for our clients, which requires efficient processes to manage data implementations, data production, data quality and data security. The Data Analysis function provides insight into different aspects of the data operations function right from raw data files to the quality of data in the deliverables.
The Data Analyst will be responsible for data management and data quality. In this role, you will host and facilitate discussions with healthcare data carriers to manage data intake and ensure all client data requirements are discussed and...
The Data Integration Specialist 1 develops, enhances, and provides insight for data integration and serves as a subject matter expert for healthcare claims analysis utilizing both technical expertise and business acumen. This role also provides consultative analytical support to internal and external customers on various projects and conducts detailed claims analysis, assists in model development, assists in statistical analysis, and ad-hoc reporting as prioritized by management. The position communicates the outcomes of analysis to business owners, senior management, and clients in a manner that adds insight and...
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, organizational skills, and understanding of claim selection methods in conjunction with extensive knowledge of Medicare and Commercial payer requirements associated with Inpatient, Outpatient, and Physician based healthcare payment systems...
As a Concept Development Analyst (CDA) within the Clinical Chart Validation team, you'll spearhead the identification, creation, and implementation of inpatient claim selection rules focusing on the payment integrity of the billed DRG. Leveraging your industry experience and deep knowledge of inpatient coding practices, APR-DRG methodologies, and billing regulations, you'll craft innovative strategies to enhance claim selection processes, contributing directly to payment integrity for our clients.
As a Concept Development Analyst (CDA) within the Clinical Chart Validation team, you'll spearhead the identification, creation, and implementation of inpatient claim selection rules focusing on the payment integrity of the billed DRG. Leveraging your industry experience and deep knowledge of inpatient coding practices, APR-DRG methodologies, and billing regulations, you'll craft innovative strategies to enhance claim selection processes, contributing directly to payment integrity for our clients.
The Auditor Retail role is an entry level position responsible for auditing client data and/or documentation on behalf of Cotiviti’s clients and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, identifies and inputs recovery claims, voids, or other over-underpayment types. Documents relevant facts, information, and conclusions drawn to support the work performed so other...
Join our dynamic Revenue Cycle team within the Yield Management Division as a Senior Revenue Cycle Specialist. Collaborate closely with other members of Yield to exceed department expectations.
As a Senior Revenue Cycle Specialist, you will lead critical functions ensuring departmental excellence. Your role involves resolving complex issues, analyzing discrepancies, and driving efficiency in payment processes across multiple platforms. Additionally, a Senior is a subject matter expertise and works directly with the Team Lead to ensure the...
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.
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...
The Sr Quality Analyst tests web applications and software to ensure standards are met by reviewing requirements, specification, and technical design documentation, identifying risk to system functionality, creating test plans and executing test cases.
The Client Policy Manager provides expert consultation on coding & clinical policy guidelines . This role works directly with our health plan clients and manages our clients payment policies and ensures they are accurate, up-to-date, and complete. This role is responsible for interpreting and assessing payment policy for clients and provides consultation and policy advice. This role works with a team of others: Medical Director, Client Managers, and Financial professional to deliver and implement clinical & coding guideline changes to their assigned clients.
The Client Services Manager is responsible for leading the cross-functional client team and providing the highest level of service to our clients. The role serves as both internal and external client liaison, including triaging, managing, monitoring, and support of a client-related activity, primarily related to Cotiviti Prospective Claims Accuracy products.
The Sr. Quality Analyst manually tests the functionalities of the features delivered in the Application developed using Oracle Database (PL/SQL and SQL), Rest services, web applications, and related software in the Payment Policy Management platform 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. You will be part of the team helping build and deliver software using SAFe practices, focusing on one or more specific initiatives with the team. As this team works primarily on the East Coast, we prefer a candidate who is...
The Sr. Software Engineer is primarily responsible for the performance and stability of critical applications. You will be expected to implement changes, bug fixes that support onboarding of new clients and quick resolution of production issues. You are expected to foster high performing technical teams. You will be required to collaborate effectively with senior developers, offshore development team members, business owners, project management, and other internal stakeholders.
This is an onsite position at our Blue Bell, PA office.
In the End User Computing Analyst role, you will provide support for internal employees for all IT services. You will also process incoming technical support incidents and requests through the ServiceNow & JIRA ticket queue while maintaining service level agreements.
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. 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 management team. This role...
Our Healthcare Data Analytics company seeks AVP Engineering within our Payment Integrity business. In this role, you will lead, direct, and manage the cross-functional technology delivery team. You will handle all the operational
aspects of software development to deliver business and project objectives. In addition, you will provide technical,
administrative, and people leadership for multiple, diverse, geographically distributed teams.
Cotiviti is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking a dynamic and innovative intern to join our Content Team for a Summer Intership. The ideal candidate will bring fresh ideas and perspectives to help us revolutionize our content delivery and management. With a focus on...
A Manager of Revenue Cycle 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 Manager, Revenue Cycle position is responsible for providing leadership and management for one or more accounts or significant audit support projects. Oversee audit support revenue cycle activities for assigned account to maximize valid claim identification and overpayment recoveries, meet contractual commitments, and deliver customer satisfaction...
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 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
The Data Scientist I is focused on machine learning solutions in Healthcare Technology and builds value-oriented, production level machine learning solutions. This is not a research oriented data scientist; instead you will apply your knowledge and experience to real world problems, and seek to utilize Artificial Intelligence and Machine Learning to 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...
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.
The Business Operations group works in small project teams to identify and address complex business challenges. The team operates like an internal consulting group to define and drive strategic, operational, and organizational improvements across the business.
Successful candidates will be self-motivated, intellectually curious, a fast learner, comfortable with ambiguity and working independently, able to focus on details while thinking strategically. They will have the ability to solve business problems of moderate to complex scope and deliver insights that enable timely and effective operational...
The Software Engineer is responsible for the design and development of software applications and reusable software components for the Cotiviti, Inc. 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.
Hands-on technical role to support our 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 VBA, Project management, Comfort...
We're looking for an Auditor 1 to join our Retail audit team. 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.
This job can be US-remote or Canada (Ontario area remote).
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....
The Senior Retail Auditor position is responsible for developing new and existing audit concepts, gaining client acceptance, training all audit levels to execute audit projects and evaluating the effectiveness of audit concepts with the goal of auditing client data generating high quality recoverable claims for the benefit of Cotiviti and our clients.
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.
The Director, Audit Operations (Retail) position is responsible for providing leadership and management for our vast and expanding global client base. Oversees all audit activities for assigned accounts to maximize team performance, meet or exceed 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 management and development.
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 seeking an experienced Manager, Engineering to lead our team. This individual will play a crucial role in overseeing the development of strategic perspectives regarding IT architecture and business needs. The Manager of Engineering will develop and implement architecture software strategies while exemplifying strong software development experience when working in an...
As a Senior Data Engineer, you will work with the team to build complex data pipelines using various data ingestion platforms as well as several new and exciting products in the Big Data/Advanced Analytics space. You will operate in a fast-paced environment where multiple project deliverables are coordinated within specified deadlines. The primary responsibility of this role is to deliver accurate and timely data across various products to enable revenue for the company. The ideal candidate would have data analysis and data pipeline development experience using big data tools (like Spark, Scala, Hive), relational databases, advanced SQL skills. Healthcare knowledge is a plus.
Develop documentation standards and formats for release notes, printed manuals, help files, and other media as needed by the organization. A primary responsibility for design, editing, and upkeep of knowledge management assets.
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 Auditor, DRG Coding & Clinical Validation position has an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding in reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy.
The Retrieval Quality Assurance Manager will oversee the daily functioning of the quality department and track the performance and quality of employees’ work, primarily in Retrieval Operations, which is our call center for retrieving medical records. This role also requires frequent and substantive contact with internal customers and management.
Sales Solution Manager – Payment Accuracy: Reporting to the leader of Cotiviti’s Sales Solution Management function, the Sales Solution Manager is a sales support, selling and development role dedicated to supporting Sales VPs in the sale of our Clinical Chart Validation, Coordination of Benefits (COB), and Data Mining solutions. This role requires industry and domain expertise in health plan payment accuracy.
Candidate should have at least two years of experience with inside sales, sales development, or a similar customer-facing role within...
The SVP, Client Engagement leads the relationship between Cotiviti and our clients and prospects. This role serves as the client’s/ prospect’s advocate, including monitoring and supporting all activity and managing problem resolution, escalating customer issues quickly, if necessary. Responsible for managing, tracking, and closing all client issues.
The critical function of a Contract Compliance Senior Auditor is to serve as the lead for contract compliance audit services. This role requires a working knowledge of how to deliver contract compliance audit services in many industries and with a variety of contract types. The work requires the ability to execute audit steps as well as review for accuracy and appropriateness, the work of others, including the assessment of transaction data in relation to relevant contract provisions, and investigation of apparent areas of non-compliance with contract provisions. Successful candidates will be critical thinkers, able to demonstrate the ability to identify risks, develop audit plans, determine...
The Training Consultant of Implementations is responsible for providing effective and relevant training to our clients through online, in person and recorded sessions. This is achieved through evaluating the Training Request, communicating with the client and the internal support team, and utilizing tools and techniques to deliver on the objectives. They will apply different forms of technology to measure the success of the training and make updates to the strategy based on the results.
The Records Processing Agent processes incoming and outgoing mail containing medical records and requests for records as well as document reproduction while maintaining production and quality levels through tracked metrics.
This is anONSITE position at our South Jordan, UT location. This is aTemporary position, approximately 8 months.
The Sr. Product Manager (within Payment Accuracy Product Suite) will be responsible for leading pharmacy / PBM product roadmaps supporting product growth. This role will enhance and extend the Cotiviti product roadmap for our PBM clients. This role will serve as product subject matter expert working closely with stakeholders for product requirements, design and delivery.
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 Senior Attorney will provide high quality legal support to the Company, its business units, regional teams, and product and functional teams including sales and marketing, corporate development and other functions. The Attorney will be expected to review, draft, and negotiate a large number of complex client transactions within a corporate environment. The successful candidate will assist the Lead Counsel in advising senior company leadership on legal and risk management issues.
The Business Analyst will be responsible for driving results by supporting the product team in their efforts to deliver new products, enhancing existing products, and to implement medium to large scale projects. In addition, they will support activities related to user acceptance testing for the above.
The Auditor, DRG Coding & Clinical Validation position has an extensive background in either facility-based nursing, clinical documentation, and/or inpatient coding and has a high level of understanding in reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy.
As a Data Engineer, you will work with the team to build complex data pipelines using a new cutting-edge Data Ingestion Platform as well as several new and exciting products in the Big Data/Advanced Analytics space. You will operate in a fast-paced environment where multiple project deliverables are coordinated within specified deadlines. The primary responsibility of this role is to deliver accurate and timely data across various products to enable revenue for the company. The ideal candidate would have data analysis and data pipeline development experience using big data tools (like Spark, Scala, Hive), relational databases, intermediate SQL skills. Healthcare knowledge is a plus.
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...