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 Client Service Associate's (CSA) role is to ensure adequate support for the client-facing team on coding and policy-related activities. The CSA must be familiar with the day-to-day activities of the Client Policy Manager (CPM), Client Service Manager (CSM), and client-facing Medical Directors.

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 Technical Product Owner has deep Healthcare 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 Technical Product Owner also has experience working with Web Services and RDBMS Databases.

Cotiviti is looking for a dynamic and motivated intern to support Cotiviti Cares, our philanthropic arm for summer 2024.  As an intern, you will have the opportunity to gain valuable experience and exposure to the healthcare technology industry and corporate philanthropy as you work with a diverse and supportive team of professions who are passionate about making a difference. You will help to support our initiatives and help make a positive impact as you engage in activities around our Cotiviti Cares pillars for Health, Environment, Education, and Community Engagement.

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 Sr. DevOps Engineer role provides support for R&D initiatives.  The role is primarily responsible for the availability and reliability of the infrastructure and business services within R&D group: Hadoop (Cloudera) ecosphere, as well as Kubernetes/OpenShift and ML/AI environments - on-prem and in the cloud.  Heavy experience with variety of open-source technologies, as well as DevOps experience.

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 Sr. Software Engineer is primarily responsible for the design and development of software applications and reusable software components deployed in the Cotiviti product suite.  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.

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

As a Summer Intern in our Quality Engineering team, you will have the opportunity to gain hands-on experience in developing web-based applications and contributing to various stages of the software development lifecycle. Under the guidance of experienced mentors, you will work on real-world projects, collaborate with cross-functional teams, and expand your skillset in a dynamic and innovative environment.

This internship offers a unique opportunity to work on cutting-edge machine learning algorithms and their integration into software applications. Under the guidance of experienced professionals, you will contribute to real-world projects, gain hands-on experience, and expand your knowledge in the exciting field of artificial intelligence and machine learning.

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.

Data Integ Spec Anlytc IT is considered a senior team member that develops, enhances, and provides insight for data integration and serves as a subject matter expert for healthcare claims analysis. This role also provides consultative in-depth evaluation and 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 adding insight and value to our clients. This role will spend time working independently, as part of a team, and will focus on specific deadlines as well as exceptional client service. As a senior team member, the ideal candidate problem solves and coordinates the activities of other personnel.

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 consistent with established operating practices and audit procedures. This will be accomplished through effective financial audit operations management, quality and service assurance, and effective people management and development.

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 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 Scientist at Cotiviti will be given the opportunity to work directly with a team of healthcare professionals including analysts, clinicians, coding specialists, auditors and innovators to set aggressive goals and execute on them with the team. This is for an ambitious technologist, with the flexibility and personal drive to succeed in a dynamic environment where they are judged based on their direct impact to business outcomes.

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, business owners, project management, and other internal stakeholders.

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 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. This person will collaborate effectively and work with Senior Developers, QA, Product Owners, Project Management, and other stake holders. Cotiviti develops highly innovative applications in healthcare analytics to generate performance, improvement opportunities and value for our clients.

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 decision-making.

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 with very large datasets (preferably SQL server) and business understanding to mine data and automate workflows focused on identifying anomalies and errors in our client’s business transactions.  

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. Finding something new—an error in payment, deviation from an agreement, or other undiscovered bit of insight that benefits the client—is what excites us.   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 improvement of retail payment integrity, consider an opportunity to join our global retail recovery team as an Retail Auditor II.

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 Agile environment. This individual will provide guidance to employees in accordance with established policies and management directives.  

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 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. This person will collaborate effectively and work with Senior Developers, QA, Product Owners, Project Management, and other stake holders. Cotiviti develops highly innovative applications in healthcare analytics to generate performance, improvement opportunities and value for our clients.

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 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. This person will collaborate effectively and work with Senior Developers, QA, Product Owners, Project Management, and other stake holders. Cotiviti develops highly innovative applications in healthcare analytics to generate performance, improvement opportunities and value for our clients.

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 selling Cotiviti’s breadth of risk, quality, analytics, and consumer engagement solutions 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 with relevant health care Quality, Performance Analytics and Risk Adjustment experience is also key.  Deep industry / sales knowledge of all lines of business (Medicare, Medicaid, Commercial) for healthcare quality, risk, and consumer engagement solutions such as HEDIS, Medicare and Commercial Risk Adjustment is highly desirable.  The position will work remotely within the U.S.

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.

Reporting to the VP of Product Marketing, Payment Accuracy, the Product Marketing Manager, Payment Accuracy will primarily utilize their experience to support and develop key areas of the operational and strategic product marketing objectives for the Payment Accuracy Portfolio. This includes opportunities to build awareness for solutions in the market, strategic marketing planning, product launches, lead generation and acceleration of the sales process, develop portfolio of sales enablement tools, product differentiators, understanding of the market landscape, competitive offerings, and the customer buying journey. This position will collaborate across the organization (GTM, Marketing, Product, Business Operations, etc.) to deliver targeted and effective marketing programs aligned with the strategic priorities for Cotiviti to drive opportunities and help to support the revenue goals for the solution area.

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 healthcare industry. They should possess the skill and experience to work as a member of a collaborative sales team and to be responsible for sales quota, expansion of account intelligence, qualification of leads, preparing the sales materials and drive revenue growth.   The intent of the role is to provide support to the Sales VPs in their pursuit of the opportunities. By partnering with a Sales VPs, the Sales Solution Manager will learn best sales practices and efficient use of internal resources.

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 necessary data and documents to complete audit testing, and strategic methods for representing, presenting, and securing recoveries for clients, as well as future savings from root cause identification and process improvement recommendations.

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.

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 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. This person will collaborate effectively and work with Senior Developers, QA, Product Owners, Project Management, and other stake holders. Cotiviti develops highly innovative applications in healthcare analytics to generate performance, improvement opportunities and value for our clients.

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 from our clients’ suppliers in order to identify and quantify areas of financial non-compliance with contract terms. The work requires assessment of transaction data in relation to relevant contract provisions, and investigation of apparent areas of non-compliance with contract provisions.  Verified instances of financial non-compliance often result in cost recoveries for our clients, as well as future savings from root cause identification and process improvement recommendations.

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 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 in terms of medical payment policy.

This role requires proven multitasking and problem-solving skills, capable of working autonomously or in a team, adaptable to dynamic environments. Key responsibilities include managing learning management systems, supporting software queries, processing enrollments, and maintaining partner relationships. They possess strong communication skills, technical proficiency in HTML and Microsoft applications, and a solid understanding of training best practices. The role may involve up to 25% travel.