The QA I, Clinical Ops position works with the Coding & Clinical Validation Audit team focused on risk coding. The QA position monitors & reports on the accuracy of all code captures on a % of all images of their assigned coders. This position also answers all questions for their coders through the Questions Queue or via email. QA is also responsible for assisting in the remediation for their coders which include full image review of all images coded prior to release to ensure accuracy of image, for any coder below project benchmark.

The 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.

The Principal Project Manager, Lean Six Sigma is tasked with driving large, cross-discipline, company-wide process improvement and operational projects with high executive visibility. These projects include improving operational efficiency and reducing cycle times, international operations and offshoring, deployment of new systems, and other projects as directed. As each improvement project is different, the expectation is to utilize a variety of tools, approaches, and formal methodologies to successfully complete the objectives. Inter-company consulting engagements comprise the majority of this positions’ scope of work with the remainder focusing on training, coaching and mentoring...

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 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.

The DevOps Associate Engineer primary responsibility is aiding in cloud automation, best practices and enhancements on our Cloud Platform Engineering team. The mission is to support teams by providing infrastructure, resources, and tools that allow them to automate, develop, self-service and experiment. The Associate DevOps Engineer will also help with continuous improvement in our software development life cycle by improving our release processes, enhancing our tooling, and driving automation.

Executes the program governance and project management components of the organization's portfolio of strategic roadmap initiatives. Maintains a broad understanding of multiple BU’s, with a focus on strategic program management to help ensure that projects align to the organization’s long-term strategy, are appropriately prioritized, completed on time, within budget, and to the satisfaction of the customer or stakeholder. The Enterprise Portfolio Management Senior Manager must have a blend of strategic foresight, analytical depth, leadership & Business

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 Corporate Strategy Associate is member of the Corporate Development and Strategy team at Cotiviti. This person will be responsible for supporting the company’s annual strategic planning process, assisting with new product market research and business cases, and performing analysis and research across a variety of strategic topics. Reporting to the Vice President of Corporate Development and Strategy and working in partnership with Product Leads, the Corporate Strategy Associate will provide support for revenue growth pursuits within and across Cotiviti product areas, supported with analytical rigor.    

As a Senior Systems Engineer, you will lead initiatives and support operations surrounding Microsoft 365, Exchange Online, On-Premises Exchange environments, Proofpoint Email Security, and Microsoft Security & Compliance solutions. Your role involves resolving escalated issues, implementing robust infrastructure solutions, and mentoring junior staff. You will also take ownership of engineering tasks associated with identity and messaging platforms while ensuring security, compliance, and performance excellence.

We lead the industry in the breadth and depth of how we support our customers—by becoming an extension of their internal team. Helping our customers deliver world-class care and service is the Services Team. The Services team is seeking a Business Analyst, who will operate as a spokesperson for the client’s business needs as they interact with the IS and IT groups to determine appropriate computer-related solutions to business problems.  The Business Analyst provides analysis, definition and direction to computer-related development and maintenance activities, and assists with ensuring that correct business functionality, requirements, and industry standards are addressed...

The Technical Architect provides architectural leadership and guidance in their assigned business area, aligning solution development efforts with the broader architectural vision and roadmap. A Technical Architect’s skills and knowledge must include multiple domains (Application/Solution architecture, Technical/Infrastructure architecture, Information/Data architecture), and experience with relevant implementation technology, platforms, and tools. As a leader, a Technical Architect is expected to influence the assigned organization and work independently with senior business and IT leaders, while acting as a mentor and role model within the development teams. The Technical Architect is accountable...

The Cotiviti Retail division are seeking an experienced Manager, Engineering to lead our engineering team and work closely with Retail operations. 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.  

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.

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.   We are developing an advanced innovation platform designed to allow non-developers to swiftly transform concepts into practical solutions. This platform...

 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 solution requirements.  They have deep knowledge of domain and strong experience in collaborating with diverse teams including product managers, software developers, testers, and teams such as Client Services, Operations, Clinical, Data Science, and Marketing. 

A Senior Revenue Cycle Specialist is a member of the Revenue Cycle team within the Payment Integrity area of Cotiviti. This department may work directly with other members of Yield to ensure expectations are accomplished. The Sr. Specialist position is responsible for complex levels of recurring and 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, etc.). Other responsibilities will include solving complex issues that have been identified and being a point person for other Revenue Cycle Specialists within the department. A Senior Specialist will...

The Senior Data Product Manager drives the discovery, design, development, and implementation of highly scalable analytic tools including self-serve BI dashboards, AI/ML models, automated reports, and curated datasets.  This role owns the voice of the customer and partners with data engineers, BI developers, data analysts, and data scientists to develop analytic tools that inform decision-making and accelerate growth.  This role also drives the implementation of product management best practices / tools, leads the development of data-driven thought leadership, and mentors junior team members.

The Vice President, Business Development – Government Healthcare is responsible for devising and executing the strategy for new business opportunities and customers in the Federal Government Healthcare market.  This role will drive increased revenue through new contract awards in the Federal Government Healthcare market for the Veterans Administration, Defense Health Agency, and/or the Centers for Medicare and Medicaid Services, and as appropriate other Federal/State Agencies.  This position is responsible for activities in the full business development / sales cycle for Government procurements, to include: opportunity identification, opportunity qualification, opportunity capture management, proposal support, pipeline management, and agency...

The Senior Manager, Corporate Strategy and Pricing is a member of the Corporate Development and Strategy team at Cotiviti. This person will be responsible for running Cotiviti’s annual strategic planning process, leading various strategy initiatives to drive growth and enhance Cotiviti’s competitive position, and implementing new pricing models and market-driven pricing activities across the product portfolio. This person will collaborate with senior leaders and stakeholders across the organization to align on priorities and communicate progress and outcomes.

The Data Product Manager drives the discovery, design/development, and implementation of highly scalable analytic products including self-serve BI dashboards, AI/ML models, automated reports, and curated datasets.  This role owns the voice of the customer and partners with data engineers, BI developers, and data analysts/scientists to develop data products that inform decision-making and accelerate growth.  The Data Product Manager is passionate about harnessing the power of data to inform decision-making and developing analytic tools that drive business value. 

We are seeking a highly experienced and dynamic Strategic Sourcing Director to lead our procurement and sourcing initiatives. The ideal candidate will have a proven track record in strategic sourcing, supplier management, and cost optimization. This role requires a visionary leader with exceptional negotiation skills and the ability to drive continuous improvement in our sourcing processes.

The Technical QA Analyst is knowledgeable in both the configuration and testing of our cloud based omni and multi-channel healthcare engagement solutions and responsible for their release into our production environment. This is done through proprietary tools that are integrated with Amazon Web Services, third party vendors, and conventional code languages. This role is responsible for contributing towards the daily release of omni-channel solutions implementations per the client agreed scheduled dates and times, by partnering with multiple teams across the enterprise to ensure...

The Senior Solution Architect is responsible for creating best-in-class business offerings. This is accomplished through collaboration with business leaders, sales and support teams, and client conversations. The Senior Solution Architect will have responsibility for establishing and sustaining processes and practices that support present and future sales and implementations, ensuring sales are aligned with current technical offering and capabilities, and that custom client requests are substantiated and well understood. The Senior Solution Architect should have a passion for helping others understand our technical solutions and architecture, creating well defined...

Cotiviti is currently looking to add an industry leading Data Scientist I - ML, who is focused on machine learning solutions to join our Enterprise Data Science Team and build value-oriented, production level machine learning solutions.  This role is not for research-oriented data scientist, but rather should be of interest to those that want to apply their knowledge and experience to real world healthcare problems and seek to utilize machine learning and artificial intelligence to reduce the cost of healthcare and improve the management of healthcare. With access to dedicated on premise and cloud based big data solutions, this role will work with a vast amount of structured and unstructured data,...

The Senior Technical Specialist role is a key contributor to our Content and Enablement team, playing a crucial role in supporting the Payment Integrity Business Unit. This position collaborates with various divisions and leadership levels across the organization.   The Senior Technical Specialist role will be responsible for working with Product Owners and Technical Architects to define project scope, technical direction, and project milestones. You will have responsibility for working with other stakeholders to define business requirements, acceptance criteria and non-functional...

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,...

The Implementation Consultant assists in the testing and implementation of Cotiviti’s solutions purchased by that client. The Implementation Consultant will generally be involved in installing & configuring under the direction of the Technical Project Manager and/or Implementation Consultant/Architect and may do so either at our offices or at client sites. This includes installation of products on client hardware; configuration and development of programs, tasks and guidelines, and setup to fully implement a Cotiviti solution. Duties can range from delivering product training to new client specific requirements, development and deployment. The role involves client coordination...

The Director, Audit Operations (Contract Compliance Recovery Audit) position is responsible for providing leadership and management for our vast and expanding global client base. Oversee the existing and expanding team in the delivery of all contract review and financial audit activities for assigned accounts to maximize team performance, ensure our client’s service providers are fulfilling their 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...

The Vice President of Audit Operations (Contract Compliance Recovery Audit) will lead and grow our global contract compliance practice within both the retail and commercial sectors. This role involves not only managing the current business unit but also collaborating with the sales department to identify and secure new clients and service opportunities. The ideal candidate will be adept at managing a contract compliance recovery audit business unit with a focus on profitable growth, resource optimization, talent development, market trend analysis, and industry engagement.   The Vice President will provide leadership and management for our...

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

The Data Scientist II - AI/ML will apply knowledge and experience to real world problems and seek to utilize their skills reduce the cost of healthcare and improve health quality and outcomes. With access to dedicated on premise and cloud based big data solutions, the team can work with a vast amount of structured and unstructured data including claims, membership, physician demographics, medical records and others to begin to solve some of the most pressing healthcare issues of our time. A Data Scientist at Cotiviti will be given the opportunity to work directly with a team of healthcare professionals including analysts, clinicians, coding specialists, auditors and innovators to set...

The Manager, Internal Audit is responsible for planning, executing, and reporting on operational, financial, Information Technology, regulatory and SOC1 related audits/reviews.

The Senior Implementation Program Manager will be responsible for managing and coordinating multiple implementation projects across various product lines within Cotiviti This role will serve as the primary liaison between the Customer teams and the Cotiviti teams including implementation/delivery, Product and other relevant teams as necessary, ensuring that products/solutions delivered align with agreed upon Customer requirements and the intended business outcomes. The successful candidate will also be responsible for capturing Customer feedback, understanding the reasons behind any gaps, and managing the process to triage and resolve these gaps. The candidate will also support the internal delivery teams from program...

Cotiviti is seeking a Senior Operations Engineer to join our Engineering Team. The Senior Operations Engineer works primarily with enterprise customers of Cotiviti products, proactively assisting them with post- sales installation, configuration, upgrade, troubleshooting and day to day operational management. Responsibilities include leading the Engineering team and Customers to address complex technical and application issues affecting product performance and customer adoption of Cotiviti products. The Senior Operations Engineer will collaborate with Development, Sustaining Engineering, and Sales Engineering teams to resolve support...

The Sr. Implementation Program Manager will be responsible for managing and coordinating multiple implementation projects across various product lines within Cotiviti. This role will serve as the primary liaison between the Customer teams and the Cotiviti teams including implementation/delivery, Product and other relevant teams as necessary, ensuring that products/solutions delivered align with agreed upon Customer requirements and the intended business outcomes. The successful candidate will also be responsible for capturing Customer feedback, understanding the reasons behind any gaps, and managing the process to triage and resolve these gaps. The candidate will also support the internal...

The Delivery/Project Manager-Public Sector will be responsible for managing and coordinating multiple implementation projects within Cotiviti. This role will serve as the primary liaison between the Customer teams and the Cotiviti teams including implementation/delivery, Product and other relevant teams as necessary, ensuring that products/solutions delivered align with agreed upon Customer requirements and scope. The successful candidate will also be responsible for capturing Customer feedback, understanding the reasons behind any gaps, and managing the process to triage and resolve these gaps. The candidate will also support the internal delivery teams from program coordination,...

Join the Cotiviti Security team and be at the forefront of protecting our cutting-edge hybrid cloud infrastructure and applications! We're on the lookout for a dynamic Principal Cloud Security Engineer to elevate our security game. In this exciting new role, you'll be the driving force behind integrating top-notch security practices into our DevOps pipeline, ensuring our applications and infrastructure are secure, compliant, and rock-solid. If you have a passion for DevSecOps and a deep understanding of security principles, DevOps practices, and frameworks like NIST 800-53, we want you on our team!

Cotiviti is looking for a candidate to join our team as a Regional Account Manager,  Healthcare Payer Sales. This is a direct sales position with quota responsibility. The ideal candidate will be an articulate, high-energy, self-motivated sales professional with a minimum of 10 years’ experience selling enterprise software solutions to the health insurance industry. If a candidate has experience selling B2B, middleware, data transformation solutions, business intelligence software, or value- based care that’s a plus. Regional Account Manager, Payer Sales will be responsible for managing all Health...

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.

Cotiviti’s Operational Insights team is seeking a highly motivated and experienced Senior Technical...

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 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 Product Director will drive strategy for Cotiviti’s Payment Integrity Client platform product roadmap. This individual will have responsibility and leadership for understanding and prioritizing market needs, performing competitive analysis, performing product discovery, supporting design, delivering business cases and leading delivery and commercial product launches for new products and capabilities

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.

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 Cotiviti’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...

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...

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.   The critical function of a Contract Compliance Auditor I is to audit billings from our clients’ suppliers in...

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.