Lead the vision, strategy, and execution of all training, enablement, and certification programs for the Edifecs Business Unit. Manage the education business P&L and oversee the modernization of L&D functions using AI and LMS tools.
Cotiviti
111 Remote Job Openings at Cotiviti
The role involves providing specialized administrative support for audit engagements, including claim level reviews and payment recalculations. It also requires generating reports to analyze trends and ensuring the accuracy of claim submittals prior to client submission.
Develop and deploy Generative AI and machine learning solutions to improve healthcare payment integrity and quality of care. Collaborate with stakeholders to assess business problems and build end-to-end data pipelines and models for production.
The Implementation Manager is responsible for the operational execution of project plans for new and existing customers. They lead cross-functional teams and partner with internal departments to ensure successful delivery and process improvement.
Investigate suspected healthcare fraud, waste, and abuse through data analysis and interviews with relevant parties. Report findings, negotiate settlements, and support legal proceedings including testifying in court.
The Technical Specialist manages project milestones, product configuration, and process improvement efforts within the Coordination of Benefits area. They collaborate with cross-functional teams to ensure quality deliverables, documentation, and successful product implementation.
Auditor Clinical Validation Outpatient Specialty Clinical
Cotiviti
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Full Time
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4 days ago
Cotiviti
Responsible for auditing outpatient and specialty claims to ensure coding accuracy, medical necessity, and appropriateness of treatment settings. The role involves utilizing audit tools to document results and suggesting process improvements to enhance recovery and client satisfaction.
DRG Validation Auditor - Off Hours Work (2nd, 3rd, or weekend shift work)
Cotiviti
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Full Time
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5 days ago
Cotiviti
Perform DRG validation and clinical reviews for inpatient claims to ensure coding accuracy and appropriateness of treatment settings. Document audit results and utilize proprietary systems to generate audit determinations and letters.
Responsible for researching, maintaining, and quality assuring Drug and Biological policies by translating industry references into business logic. Provides clinical coding expertise to support client inquiries and mentors new team members on policy reviews.
Develop and maintain Spark and SQL scripts for data management, validation, and integration. Create data pipelines and collaborate with engineering and cloud operations teams to resolve environmental issues.
Develop and deploy Generative AI solutions to improve healthcare payment integrity and quality of outcomes. Collaborate with stakeholders to assess AI use cases and integrate models into the company's machine learning platform.
The Project Manager aligns Outpatient Specialty policies across Commercial and Government sectors while driving process improvements through data analysis. They are responsible for managing project documentation, monitoring KPIs, and coordinating with IT and other departments to ensure operational efficiency.
Investigate suspected healthcare fraud, waste, and abuse using data analytics and claims review to identify atypical billing patterns. Report findings through written summaries and support legal proceedings by testifying in court or collaborating with law enforcement.
Leads a team of coders to oversee CMS-HCC and HHS-HCC production and quality accuracy. Manages staffing, production planning, and client deliverables while monitoring productivity through data analytics.
Audit medical records and healthcare claims to ensure accuracy in medical coding and compliance with health plan policies. Prepare detailed reports on findings and recommend process improvements to correct deficiencies.
Lead a Coordination of Benefits team by managing performance, recruiting talent, and ensuring internal and external client requirements are met. Act as a subject matter expert on CMS and NAIC guidelines to drive operational efficiency and payment accuracy.
Responsible for reviewing and analyzing complex member data to identify recoverable Coordination of Benefit claims and establish the correct order of liability. The role involves using proprietary software to input recovery information and managing moderate to complex audit projects.
Auditor Clinical Validation (Place of Service, Short Stay & Readmission)
Cotiviti
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Full Time
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6 days ago
Cotiviti
Perform retrospective clinical chart reviews on Readmission and Place of Service claims using nationally accepted guidelines. Document rationales for audit findings and utilize proprietary systems to generate audit determinations and letters.
The specialist audits client data to identify over and underpayments and generates high-quality recoverable claims. They document findings and communicate audit recommendations to supervisory auditors to ensure billing compliance.
The Implementation Director manages the delivery of services and technology to healthcare clients from pre-sales through production verification. This includes coordinating cross-functional teams, managing project milestones, and maintaining high-level client relationships.
Oversee and maintain ETL processes and data pipelines to ensure accurate and timely data delivery for healthcare management. Collaborate with stakeholders and technical operations to troubleshoot complex database issues and optimize query performance.
Perform complex retail audits to identify over and under-payments of claims and validate merchandise inventory payments. Develop audit concepts and collaborate with IT and Business Optimization to improve reporting tools and efficiency.
The Data Engineer is responsible for creating and optimizing SQL scripts to manage data implementations, production, and quality. They collaborate with engineering and DBA teams to troubleshoot environmental issues and maintain data integrity compliance.
Conduct research on Generative AI and AGI for healthcare treatment, payment, and operations use cases. Develop AI models, architectures, and systems while contributing to AI governance and academic collaborations.
Oversee the data engineering efforts to provision scalable, reliable data pipelines and lead a team of data engineers in delivering quality code and building data products. Establish a metrics-driven approach to measure team performance and influence the vision for the data engineering platform.
The intern will research and develop advanced healthcare informatics solutions with a focus on Agentic AI. They will collaborate with cross-functional teams to drive innovative research and practical implementation in healthcare environments.
Lead Cotiviti's external communications strategy to drive brand visibility and executive thought leadership within the healthcare ecosystem. Manage media relations, crisis communications, and the development of compelling narratives to elevate the company's reputation.
The specialist reviews and analyzes claims and member data to identify recoverable claims and establish the correct order of liability. They are responsible for inputting recovery information into proprietary software and resolving client disputes regarding overpayments.
Acts as the subject matter expert for consumer engagement solutions, bridging the gap between customer needs and product capabilities. Partners with Sales and Product teams to lead demonstrations, conduct discovery sessions, and support RFP responses for health plan clients.
Design and evolve intelligent workflow and automation solutions using AI-native development tools and open-source engines. Establish architectural standards and lead a Center of Excellence for AI-enabled workflow development to ensure scalable and secure solutions.
Lead the design and delivery of complex, scalable software and data solutions for pharmacy applications across hybrid environments. Drive technical strategy, mentor engineering teams, and collaborate with stakeholders to align technology with business objectives.
Develop and execute audit concepts to identify billing compliance issues and recoverable claims for healthcare clients. Mentor junior staff and collaborate with engineering to improve audit tools and reporting efficiency.
The role involves leading consultative requirements gathering and conducting sophisticated data analysis to drive operational decision-making and revenue growth. The analyst will optimize business processes, create automated reporting tools, and lead business reviews to benchmark financial performance.
Design, implement, and maintain IAM solutions across on-prem and cloud environments to ensure secure access to technology resources. Manage user lifecycle provisioning, develop governance policies, and conduct access audits for regulatory compliance.
The Senior Revenue Cycle Specialist manages complex daily financial functions, including payment posting, invoicing, and reconciliation. They serve as a subject matter expert, mentoring junior staff and collaborating with leadership to improve departmental efficiency and training materials.
Design and develop intelligent backend services and AI-native workflow orchestration solutions using Java and Spring Boot. Collaborate with architects to build scalable, secure APIs and integrate AI-driven capabilities for automation and decision support.
Lead the design and development of Java-based backend services and AI-enabled workflow automation solutions. Provide technical leadership through code reviews, mentoring engineers, and driving the adoption of AI-native development patterns.
Lead multiple software engineering teams to deliver high-quality solutions using an AI-native approach to accelerate delivery and improve effectiveness. Partner with cross-functional stakeholders to align technology execution with business priorities and healthcare compliance requirements.
The Content Analyst researches and implements medical policies while analyzing clinical content metadata from national sources. They provide coding expertise to maintain clinical edits and collaborate with QA and client teams to validate policy changes and resolve inquiries.
Acts as the clinical and technical authority to develop and validate payment integrity rules for genetic testing and laboratory services. Translates complex genomic concepts into scalable rule logic and presents these strategies to payer clients.
Drive the development and improvement of audit platforms for healthcare payment accuracy and data mining. Partner with stakeholders and engineering teams to define product visions, manage roadmaps, and ensure successful feature delivery through agile execution.
Lead the architectural design and execution for a specific business area, translating product intent into implementable specifications for AI-native solutions. Orchestrate AI agents and engineering workflows to deliver scalable, secure, and maintainable applications within a regulated healthcare environment.
Investigate suspected healthcare fraud, waste, and abuse using data analytics and claims review to identify atypical billing patterns. Report findings through written summaries and support legal proceedings by testifying in court or collaborating with law enforcement.
The intern will research and develop advanced generative AI and AGI solutions to improve healthcare treatment, payment, and operations. Responsibilities include developing LLMs, maintaining AI governance, and collaborating with cross-functional teams and academic partners.
Build and lead the Business Architecture capability for the Payment Integrity business unit to improve business-to-technology alignment and scalability. Define target-state operating models, value streams, and business capabilities to enable automation and AI-driven innovation.
The Technical Product Owner drives solution definitions by translating business requirements into testable application software solutions. They manage and prioritize the team backlog while collaborating with cross-functional teams to meet program objectives.
Lead a team of analysts and administrators in developing complex audit concepts and updating policies based on clinical and regulatory changes. Oversee the implementation of AI models and business tools to optimize coding-based content and audit performance.
Drive new sales growth within the National Accounts segment by building executive relationships and advancing complex enterprise opportunities. Lead multi-stakeholder sales pursuits from prospecting through contracting while orchestrating cross-functional resources.
The Content Analyst II researches and analyzes medical policies to create clinical coding edits and business logic. They are responsible for maintaining the policy library and providing clinical expertise for customer inquiries and appeals.
Design and implement the frontend for a centralized AI platform, focusing on intuitive interfaces for agent creation and monitoring. Develop modular, reusable chatbot components for integration across various SaaS products within the ecosystem.
Develop and maintain backend APIs and services for a centralized AI platform using Python. Focus on implementing agentic frameworks, lifecycle management, and secure multi-tenant features.
Design and build the backend infrastructure and scalable RESTful APIs for a centralized AI platform. Lead the development of Python/Java SDKs and manage the lifecycle of AI agents within a multi-tenant architecture.
The Medical Policy Director serves as a subject matter expert in coding and medical payment policy to optimize value for health plan clients. They are responsible for directing the Medical Policy Committee and advocating for the adoption of new policies through data-driven presentations.
Provide administrative support to the Coordination of Benefits and Data Mining teams to assist in audits and overpayment generation. This includes communicating with insurance providers and Medicare to obtain member eligibility details and entering data into internal tools.
Develop and execute complex audit concepts to identify recoverable healthcare claims while ensuring high quality and client acceptance. Mentor junior audit staff and collaborate with business optimization teams to improve audit tools and processes.
The Associate is responsible for identifying and evaluating strategic acquisition opportunities and managing the end-to-end M&A execution process. This includes conducting financial modeling, performing due diligence, and preparing executive-level materials for board review.
Lead the company's pricing strategy by maintaining existing price books and creating models for new solutions. Collaborate with senior leadership to align priorities and track pricing effectiveness through KPIs and dashboards.
Develop and execute growth, renewal, and retention strategies for top-tier healthcare customers while maintaining high-level executive relationships. Act as a client advocate to resolve complex issues and collaborate with internal teams to align product development with client needs.
Ensures client policy sets and tables are accurately configured based on specific decisions and manages lower complexity payer data projects. Provides technical support regarding payment policies to implementation teams and clients while monitoring production files for accuracy.
Design and develop high-quality, maintainable software modules and reusable components for the Cotiviti product suite. Collaborate with cross-functional teams to analyze requirements, resolve software issues, and mentor team members in engineering best practices.
Automate the build-test-deploy lifecycle for cloud applications and enhance platform services within an agile environment. Collaborate with cross-functional teams to implement software configuration management best practices and maintain a secure, high-availability SaaS platform.
Serve as a coding and billing subject matter expert to optimize AI-enabled claim selection tools and payment integrity outcomes. Collaborate with data scientists and analytics teams to validate model outputs and ensure alignment with regulatory reimbursement rules.
Serve as a coding and billing subject matter expert to help AI data scientists optimize automated claim selection tools and payment integrity outcomes. Validate AI-enabled outputs for clinical accuracy and tune model logic based on audit performance trends and regulatory guidelines.
The role involves architecting and developing innovative analytics and reporting solutions using Big Data tools in an Open Source environment. Responsibilities include managing the Analytics Center of Excellence and delivering data-driven recommendations through an Agile process.
The role focuses on model validation, metrics, monitoring, and the implementation of Responsible AI frameworks to improve healthcare outcomes. Responsibilities include benchmarking existing models, managing model drift, and delivering production-grade AI solutions.
Oversee the full lifecycle of strategic partnership and vendor contracts, including drafting and negotiating complex commercial agreements. Advise internal stakeholders on legal risks, contract interpretation, and compliance requirements.
Develop and execute retail audit concepts to identify recoverable claims and improve audit processes for clients. Provide quality control oversight for auditor claims and manage client disputes regarding contract terms.
Oversee business operations within the Payment business unit to support sales, client engagement, and operational efficiency. Lead team development and implement strategic improvements to meet or exceed service level benchmarks.
Drive new logo acquisition by selling pharmacy claim editing and payment accuracy solutions to U.S. health plans and TPAs. Lead complex sales cycles and develop strategic account plans to expand market share within assigned territories.
Oversee the development and execution of complex technical initiatives using SAFe and other software delivery practices across multiple business units. Coordinate with cross-functional teams and senior leadership to ensure projects are delivered on time, within budget, and meet quality standards.
Responsible for researching and analyzing medical policies to create clinical coding and pharmacy claims editing logic. The role involves collaborating with developers and product teams to implement rule enhancements and ensure operational alignment.
The Director of Quality oversees the delivery and performance of payment integrity solutions by implementing quality measurement frameworks and driving continuous improvement. They collaborate with cross-functional teams to optimize operational processes, manage talent, and ensure service level benchmarks are consistently met or exceeded.
The Senior Auditor performs clinical quality assurance reviews of claims to ensure accuracy, compliance, and high-quality recoverable outcomes. They also mentor staff, communicate audit findings, and support process improvements within the clinical validation framework.
The Data Engineer will create, maintain, and optimize Spark and SQL scripts to manage data pipelines and ensure data integrity. They will also collaborate with engineering and cloud operations teams to troubleshoot environmental issues and support data integration tasks.
The Senior Data Scientist will design and build AI/machine learning models to solve complex analytical problems and deliver value for healthcare clients. They will collaborate with cross-functional teams to develop integrated analytic solutions, mentor junior staff, and present actionable insights to stakeholders.
The Sales VP will own and execute a new business sales strategy for dental claim accuracy solutions within an assigned territory. They will prospect, qualify, and close complex deals with Dental Benefit Administrators and Health Plans while maintaining senior-level executive relationships.
The Senior Data Engineer will manage complex data integrations, transformations, and validation workflows while ensuring data quality and security. They are also responsible for troubleshooting production issues, mentoring team members, and collaborating with stakeholders to improve business processes.
The associate auditor is responsible for performing inpatient clinical chart validations and auditing claims for coding accuracy and treatment appropriateness. They must utilize proprietary auditing systems to document findings, meet productivity goals, and identify potential claim recovery opportunities.
This role involves auditing inpatient medical claims to ensure coding accuracy, clinical validity, and appropriate treatment settings. The auditor will document findings, generate audit letters, and identify opportunities for process improvements or additional recoveries.
The Project Manager owns the end-to-end delivery of projects, ensuring plans are realistic and stakeholders are aligned. They are responsible for maintaining project artifacts, managing RAID logs, and facilitating team meetings to ensure execution stays on track.
The Payment Integrity Specialist audits healthcare claims to detect and recover overpayments while providing expert feedback to improve compliance solutions. They also review clinical documentation and support business development activities within the Payment Integrity Practice.
The Senior Support Engineer is responsible for supporting and enhancing software applications within the Cotiviti product suite while collaborating with cross-functional teams. They will analyze complex business problems, resolve technical issues, and mentor team members to ensure project deliverables meet quality and timeline standards.
Define and govern the end-to-end technical architecture for a mission-critical CMS audit platform while leading its AI-native transformation. Lead, mentor, and elevate a cross-functional engineering team while ensuring robust, scalable, and secure technical solutions.
Identify, investigate, and analyze instances of potential healthcare fraud, waste, and abuse through data analysis and interviews. Prepare written summaries of findings, conduct training, and support legal proceedings or settlement negotiations.
The VP of Client Engagement is responsible for developing and executing growth, renewal, and retention strategies for top-tier customer accounts. This role acts as a primary liaison between the company and clients, managing relationships, resolving issues, and identifying opportunities for service improvements.
The intern will research and develop autonomous Agentic AI systems to improve healthcare treatment, payment, and operational workflows. They will also assist in establishing an Artificial Intelligence Governance Program and collaborate with cross-functional teams on AI model development.
The Senior Payment Accuracy Specialist develops and implements new audit concepts while overseeing quality control for complex healthcare claims. This role also mentors audit staff and collaborates with business optimization teams to enhance audit production and client satisfaction.
The auditor is responsible for performing inpatient DRG and clinical chart validations to ensure coding accuracy and appropriate treatment settings. They must document audit results, utilize proprietary auditing systems, and identify potential claims for recovery.
The AI Program/Project Manager will lead the development and deployment of AI/ML solutions by collaborating with cross-functional teams to define project scope and roadmaps. They are responsible for driving data-driven decision-making and ensuring the successful integration of models into production environments.
The Senior Integration Solutions Engineer will design, implement, and optimize scalable integration solutions while collaborating with clients and internal teams. The role also involves providing technical leadership, mentoring junior engineers, and evaluating emerging technologies like AI and Machine Learning.
The Payment Accuracy Specialist 2 develops and executes audit concepts to identify billing compliance issues and recoverable claims within healthcare data. They also serve as a mentor and trainer for team members while collaborating with engineering to improve audit tools and reporting efficiency.
The Technical Customer Solutions Manager will act as a trusted advisor to healthcare payer clients, managing project plans and ensuring the effective use of Cotiviti products. They will lead account relationships, track operational metrics, and collaborate cross-functionally to drive client success and product enhancements.
As an AI Product Manager, you will identify clear objectives to formulate problems and create a compelling product vision. You will manage the AI product roadmap, prioritize features, and work with various stakeholders to deliver high-quality products.
The Policy Design Specialist is responsible for managing health plan clients and executing project requests, including policy configuration maintenance and implementation. They ensure policies align with industry standards and client expectations while performing quality assurance checks.
The role involves leading consultative requirements gathering sessions with stakeholders to scope analytical needs and conducting sophisticated data analysis, modeling, and insight generation across the Clinical Chart Validation (CCV) business. Responsibilities also include leading process optimization, creating automated tools and KPI reporting, and owning strategic initiatives that impact revenue.
The Program Manager is accountable for ensuring the successful delivery of Risk Adjustment products and services to strategic enterprise-level clients, requiring close partnership with Client Executives and various internal team leads. This role involves managing client-related documentation, driving client satisfaction and product adoption, and ensuring all contractual SLAs and key milestones are met.
The AI-Native Product Lead owns the single-team product backlog, translating business needs into clear, testable requirements while ensuring continuous backlog readiness for fast, iterative delivery. This role provides essential product intent and grounding context to guide both human and AI-assisted development workflows.
The Regional Vice President will manage all Health Care sales activity for key accounts, focusing on growing Cotiviti's revenues and client base within the assigned territory through prospecting and presenting product value. This role involves owning the sales process, negotiating contracts, collaborating with sales teams, and tracking key business metrics for management and clients.
The specialist drives critical, large, cross-discipline process improvement projects, often with executive visibility, aiming for impacts over $1M per project and potentially acting in a Project Management role for strategic initiatives. A significant portion of the work involves inter-company consulting, alongside supporting the company-wide Lean Six Sigma training and certification programs through coaching and mentoring.
The engineer will be responsible for onboarding customers to Risk Adjustment workflow applications by designing and developing data flows, extraction processes, and integrating client data into these workflows. This role involves building and scaling automation, redefining data strategy, and working with relational databases and Python jobs.
The Vice President will devise and execute strategy for new business opportunities within the Federal and State Government Healthcare markets, driving revenue through new contract awards with agencies like the VA, DHA, and CMS. This involves managing the full business development cycle, achieving sales targets, and maintaining key customer relationships.
The Senior Security Engineer - IAM is responsible for designing, implementing, and maintaining privileged access solutions, focusing on managing privileged credentials and enforcing least privilege principles across critical systems. This involves administering the Delinea PAM solution, integrating it with enterprise tools, and ensuring compliance through control implementation and audit evidence production.
The Lead Software Engineer will design, implement, test, and maintain innovative software products while managing the development of major features and components. They will also mentor junior developers and perform code and design reviews.
The Lead Software Engineer will contribute to the engineering team by understanding product feature requirements and delivering scalable code on time. They will work within an agile environment, focusing on design, coding, testing, and automation tasks.
The Vice President, Sales is responsible for developing and executing annual sales plans to acquire new clients and sell new solutions. This includes direct prospecting for new business, achieving sales targets, and establishing relationships with decision-makers.
The Sales VP will develop and implement effective sales strategies while managing a sales territory and quota. They will also research market trends and ensure customer satisfaction according to company standards.
The Research Medical Director interprets and assesses payment policy and medical coding information, ensuring the accuracy of the medical policy library. They also conduct research and analysis for medical policy items and educate client-facing MDs on policy updates.
The Staff Gen AI Scientist will deliver solutions to improve healthcare outcomes and reduce costs. They will work with a team to develop machine learning models and ensure their successful deployment and monitoring.
The Senior Solution Architect collaborates with sales and client engagement teams to create and define custom technology solutions. They also participate in solution development planning and execution, ensuring client needs are met.
The Sr Staff AI Scientist will deliver solutions to help clients identify payment integrity issues and improve healthcare outcomes. They will work collaboratively with a team and be responsible for the delivery of value associated with their projects.
The successful candidate will contribute to the design, coding, and implementation of an automation testing framework and validate applications end-to-end across various database systems. They will also perform performance, load, and security testing while working with an Agile scrum team.
