The Data Engineer will create, maintain, and execute 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 optimize query performance.
Cotiviti
97 Remote Job Openings at Cotiviti
The Coder I is responsible for conducting accurate and compliant diagnosis code abstraction for various risk-adjustment programs. They must communicate findings and errors professionally to team leadership to support continuous improvement.
The Concept Development Analyst supports the optimization of AI-enabled claim selection processes by providing clinical, coding, and reimbursement expertise. They partner with data science teams to validate model logic, analyze performance trends, and ensure selection methodologies align with regulatory standards.
Content Solutions Analyst II (Genetic Testing and Laboratory SME)
Cotiviti
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Full Time
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2 days ago
Cotiviti
The analyst will develop and enhance payment integrity rules by translating medical policies and coding guidelines into scalable logic. They will also conduct complex claims analysis and mentor junior team members to ensure policy accuracy and operational success.
The Talent Acquisition Business Partner will act as a strategic advisor to hiring teams to develop and drive recruitment strategies. Responsibilities include sourcing, screening, interviewing, and managing the full-cycle recruitment process to build a high-quality talent pipeline.
The SVP of Enterprise Client Engagement and Strategy is responsible for owning commercial performance, multi-year area strategy, and driving revenue growth across a $300M+ book of business. This leader also manages executive-level client relationships and drives organizational change to ensure alignment with corporate objectives.
The Lead Program Manager will design and manage end-to-end go-to-market programs to drive client experience, retention, and revenue growth. They will serve as a connective force across sales, marketing, finance, and operations to ensure cross-functional alignment and accountability.
The Product Analyst is responsible for release planning, status reporting, and writing business requirements. They collaborate with teams to allocate resources, prioritize features, and track customer bugs.
The Counsel provides legal guidance on government and commercial contracting, focusing on healthcare regulatory frameworks and federal/state programs. They are responsible for drafting, negotiating, and managing complex agreements while ensuring compliance with legal and operational requirements.
The Senior Auditor performs contract compliance and cost control audits on various construction and capital projects. They are responsible for validating billed costs, identifying cost recoveries, and mentoring other auditors on audit engagements.
Design and implement a scalable agentic AI framework and centralized platform to enable secure deployment and management of AI agents across the organization. Collaborate with cross-functional teams to integrate these AI solutions into customer-facing applications and internal tools while ensuring platform reliability and security.
The role involves handling daily administrative activities and collaborating with the auditing team to support Coordination of Benefits and Data Mining objectives. Responsibilities include communicating with insurance providers to obtain eligibility details and accurately entering claim information into company systems.
The Product Manager is responsible for defining the vision, strategy, and execution plan for the Coordination of Benefit product line. They will collaborate with cross-functional teams to manage the product lifecycle, prioritize features, and track key performance indicators to ensure business success.
The Platform Systems Analyst acts as a liaison between business stakeholders and technical teams to translate requirements into actionable specifications. They are responsible for optimizing enterprise platforms, managing data flows, and ensuring system alignment with architectural and compliance standards.
The Senior Operations Engineer manages end-to-end operations for Edifecs application instances, including deployments, configuration, and performance monitoring. They provide L2/L3 technical support to enterprise clients and collaborate with cross-functional teams to resolve complex operational issues.
The Senior Implementation Consultant will coordinate with clients to install, configure, and deploy Edifecs/Cotiviti solutions based on specific business needs. They are responsible for providing technical support, delivering product training, and mentoring internal teams throughout the implementation lifecycle.
The Senior Software Engineer II will lead the design, development, and delivery of the Early Intervention Coordination of Benefits solution on a high-volume healthcare platform. They will provide technical leadership, mentor team members, and collaborate with architects to drive innovation and ensure system scalability.
The Senior Database Engineer is responsible for designing, developing, and maintaining database applications and reusable software components within the Cotiviti product suite. They will collaborate with global teams to drive application design, resolve performance issues, and implement innovative solutions to business problems.
The Senior GCP Cloud Engineer will lead operational stability and reliability for cloud infrastructure, driving automation and incident response efforts. They will also mentor junior team members and collaborate cross-functionally to ensure scalable, secure, and resilient cloud platforms.
You will develop and deploy machine learning and generative AI solutions to identify payment integrity issues and improve healthcare outcomes. This role involves collaborating with cross-functional teams to build end-to-end data pipelines and monitor model performance in production.
The Software Engineer will design, develop, and maintain high-quality software applications and AI-powered features for healthcare analytics. They will collaborate with cross-functional teams to build data pipelines, integrate LLMs, and ensure code quality through testing and reviews.
The Senior Events Manager is responsible for the strategic planning, execution, and oversight of company events ranging from small meetings to large conferences. This role involves managing budgets, vendor relationships, and cross-functional collaboration to deliver on-brand experiences that support business objectives.
The Software Engineer will design and develop high-quality, maintainable software modules for the company's healthcare analytics product suite. They will also conduct unit and integration testing, resolve customer issues, and collaborate with cross-functional teams to ensure adherence to best practices.
The Vice President of Sales is responsible for driving new business acquisition and strategic sales planning for Retail Payment Integrity Services. This role involves prospecting, managing multi-level client relationships, and collaborating with internal teams to deliver value-based solutions to large retail and e-commerce enterprises.
The Senior Software Engineer II will lead the development and improvement of high-quality software modules within the Cotiviti product suite. They are responsible for analyzing complex technical issues, mentoring junior engineers, and ensuring adherence to technology standards.
The Platform Product Manager drives the development and improvement of audit platforms by managing the product lifecycle, vision, and roadmap. They collaborate with cross-functional teams to translate business requirements into technical specifications and ensure successful product delivery.
Establish the technical direction and architecture for a clinical AI data platform, ensuring secure and compliant PHI data pipelines on AWS. Lead the development of data quality frameworks, MLOps infrastructure, and clinical knowledge graphs while mentoring senior engineering staff.
Design and develop high-quality, maintainable software modules and reusable components for healthcare analytics applications. Collaborate with cross-functional stakeholders to analyze requirements and leverage AI tools to improve productivity and quality.
Develop and execute audit concepts to identify billing compliance issues and recoverable claims within healthcare data. Mentor junior staff and collaborate with engineering to improve audit tools and reporting efficiency.
The Technical Specialist designs and develops logic for business rules within a BRMS to support healthcare platform applications. They are responsible for testing, deploying rules into production, and maintaining detailed documentation and impact reports.
The role focuses on auditing inpatient claims for coding accuracy and clinical validation of treatment settings and services. It involves utilizing proprietary auditing systems to document results and identify potential recovery opportunities.
The Client Services Manager serves as the primary contact for clients to ensure revenue retention, satisfaction, and growth within the Clinical Chart Validation line of business. They manage the operational execution of auditing programs and lead strategic initiatives to improve client-facing reporting and production metrics.
Drive the planning, strategy, and roadmap for AI solutions and platforms across various lines of business. Manage end-to-end AI programs by coordinating with data science and engineering teams to implement scalable ML and Generative AI techniques.
Responsible for auditing inpatient claims to ensure coding accuracy and the appropriateness of treatment settings and services delivered. The role involves utilizing proprietary auditing systems to document results and identify potential recovery opportunities.
Manage the end-to-end development and completion of RFP responses while maintaining the proposal repository and tracking tools. Collaborate across departments to ensure all bid documents meet strict client deadlines and compliance requirements.
Design and implement a scalable agentic framework and centralized AI platform to support organization-wide AI initiatives. Collaborate with cross-functional teams to integrate AI agents into internal tools and customer-facing applications while ensuring security and scalability.
Design and implement the frontend for a centralized AI platform, focusing on intuitive interfaces for agent creation and monitoring. Develop reusable chatbot modules and responsive dashboards for integration across various SaaS products.
Develop and execute growth, renewal, and retention strategies for government customers while maintaining high-level relationships with C-suite executives. Lead a team to ensure customer satisfaction through proactive issue resolution and strategic account planning.
Design and implement scalable backend services and RESTful APIs for a centralized AI platform. Lead the development of agent lifecycle management while mentoring mid-level engineers and collaborating on technical architecture.
Act as a strategic advisor to healthcare payer clients to maximize product value and drive long-term success. Manage account relationships, track key performance metrics, and coordinate with product teams to resolve customer issues and implement enhancements.
The Client Services Manager coordinates cross-functional teams to ensure client satisfaction, revenue retention, and growth for PPM and CV products. They serve as the primary liaison for clients, managing operational implementation, performance monitoring, and the resolution of technical or policy issues.
Auditor Clinical Validation Outpatient Specialty Clinical
Cotiviti
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Full Time
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17 days ago
Cotiviti
Perform clinical and coding audits for outpatient and specialty claims to ensure accuracy, medical necessity, and appropriateness of treatment. Document audit results and suggest process improvements to enhance recovery and client satisfaction.
Perform daily audits on client data to ensure coding accuracy and appropriateness for reimbursement. Respond to provider appeals and provide feedback to management to enhance product efficiency.
The Medical Policy Director serves as a subject matter expert in coding and medical payment policy to guide the Medical Policy Committee and health plan clients. They are responsible for analyzing client data to identify policy optimization opportunities and presenting these recommendations to drive value.
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.
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 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.
Business Development Representative ( Retail Audit Services)
Cotiviti
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Full Time
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a month 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.
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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a month 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.
Sr Generative AI Scientist II - (Model Risk & Validation)
Cotiviti
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Full Time
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a month 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.
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.
DRG Validation Auditor - Off Hours Work (2nd, 3rd, or weekend shift work)
Cotiviti
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Full Time
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a month 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.
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.
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 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.
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 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 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.
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 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.
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.
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 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.
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 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 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 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 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 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.