Defend recovery determinations by performing extensive reviews of initial claims and provider appeal documentation. Formulate written, reference-supported responses and provide educational feedback to the audit and QA teams.
Cotiviti
91 Remote Job Openings at Cotiviti
Responsible for auditing healthcare client data to identify over and under-payments and generating high-quality recoverable claims. The role involves validating billing compliance issues and collaborating with the audit team to expand recovery concepts.
Design and develop high-quality 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.
Manage health plan clients by implementing and maintaining medical policy configurations and executing project requests. Perform data analysis and quality assurance checks to ensure claim editing aligns with industry guidelines and client expectations.
The intern will research and develop advanced healthcare informatics and AGI architectures, focusing on data agents and governance. Responsibilities include building data pipelines, designing storage layers, and testing AI components like embeddings and retrieval logic.
The manager will identify opportunities to optimize retail audit processes and drive revenue growth through data-driven insights. They are responsible for managing the report development lifecycle and leading a team of professionals to improve internal and external customer satisfaction.
The role focuses on model validation, metrics, and monitoring to ensure responsible AI practices within healthcare. Responsibilities include benchmarking existing models, detecting model drift, and delivering solutions to improve healthcare payment integrity and outcomes.
The Data Engineer is responsible for architecting and maintaining scalable data infrastructure and ETL/ELT pipelines. The role focuses on leveraging Databricks for data processing, quality assessment, and the development of a semantic layer for business analytics.
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 tools to input recovery information and managing audit projects of moderate complexity.
Facilitate the collection of funds by preparing collection letters and following up on outstanding claims with providers. Investigate claim disputes and document all activities within proprietary systems to meet productivity and quality standards.
Business Development Representative ( Retail Audit Services)
Cotiviti
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Full Time
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6 days ago
Cotiviti
The BDR is responsible for growing the sales pipeline by identifying new account opportunities and conducting outbound engagement. They collaborate with Sales VPs to execute account-level strategies and gather market intelligence on prospective customers.
Lead the design and delivery of end-to-end ML/AI systems to optimize payment accuracy and risk adjustment using clinical and claims data. Define technical strategy, build evaluation frameworks, and mentor senior engineers to elevate organization-wide ML standards.
Manages and maintains accurate client medical payment policies while acting as the primary liaison between internal teams and external clients. Conducts research, performs data analytics, and coordinates policy reviews with Medical Directors to ensure compliance and accuracy.
This role focuses on auditing inpatient claims for coding accuracy and clinical validation of DRG/APR-DRG. The auditor is responsible for documenting results, ensuring treatment appropriateness, and identifying new claim types for potential recovery.
Own the end-to-end product development lifecycle for healthcare enrollment initiatives, from discovery and roadmap planning to release execution. Act as the primary liaison between business stakeholders and engineering teams to translate regulatory needs into technical specifications.
The Project Manager owns the delivery of payment projects from initiation to close, ensuring realistic planning and stakeholder alignment. Responsibilities include maintaining RAID logs, facilitating team meetings, and utilizing AI to amplify productivity in reporting and documentation.
Develop and execute growth, renewal, and retention strategies for top-tier healthcare customers. Act as the primary liaison and advocate for clients to ensure satisfaction and align product development with client needs.
Team Lead - Appeals (Place of Service, Short Stay & Readmission)
Cotiviti
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Full Time
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11 days ago
Cotiviti
Supervise a team of Clinical Validation Auditors focusing on Place of Service, Short Stay, and Readmission appeals to ensure high-quality recoverable claims. Manage work distribution, auditor performance, training, and adherence to client SLAs and clinical standards.
The analyst is responsible for researching and analyzing medical policies to create clinical coding and pharmacy claims editing logic. They collaborate with developers and product teams to implement rule enhancements and ensure operational alignment on the content roadmap.
Perform clinical quality assurance reviews of daily clinical validation audits to ensure accuracy and compliance with quality standards. Communicate with initial auditors to resolve differing decisions and identify opportunities for process improvements.
Manager Engineering (Healthcare Solutions) Post ID Engineering
Cotiviti
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Full Time
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13 days ago
Cotiviti
Lead software development teams to improve healthcare insurance outcomes while driving long-term architecture strategies. Manage internal stakeholders, staff performance, and ensure compliance with HIPAA privacy and security standards.
The Medical Director serves as a subject matter expert in coding and medical payment policy to guide health plan clients. They are responsible for directing the Medical Policy Committee and identifying value-creation opportunities to support client growth.
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 processes and efficiency.
Senior Technical Program Manager (Model Risk and Responsible AI)
Cotiviti
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Full Time
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16 days ago
Cotiviti
Oversee the development and execution of complex AI/ML initiatives using SAFe and other software delivery practices. Coordinate cross-functional teams to manage the model lifecycle from risk assessment through deployment and monitoring.
Lead and mentor a high-performing field sales team to drive the acquisition and expansion of Retail and Commercial Payment Accuracy solutions. Develop strategic sales plans, manage executive-level relationships, and collaborate cross-functionally to ensure revenue growth and client retention.
Sr Generative AI Scientist II - (Model Risk & Validation)
Cotiviti
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Full Time
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19 days ago
Cotiviti
The role focuses on model risk management, validation, and monitoring of GenAI models to improve healthcare outcomes. Responsibilities include benchmarking existing models, detecting model drift, and implementing Responsible AI frameworks.
Drive the strategy and lifecycle management of the Fraud, Waste, and Abuse product suite to improve healthcare payment integrity. Collaborate with cross-functional teams to translate market needs into scalable analytics-driven solutions and integrated platforms.
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.
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.
Auditor Clinical Validation Outpatient Specialty Clinical
Cotiviti
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Full Time
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24 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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25 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.
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.
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.
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.
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.
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.
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.
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 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.
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 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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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 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 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 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 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 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.
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 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 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 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 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 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.
