Cotiviti

General

• Receive business rules from various internal Cotiviti teams
• Collaborate with internal partners to clarify the intent of each rule
• Design and develop rule logic for integration into the Business Rules Management System (BRMS)
• Conduct deployment and testing of rules in a test environment to verify accuracy
• Implement rules into production environments
• Communicate effectively with operations and key stakeholders following production deployment
• Maintain and update documentation associated with each rule
• Produce impact reports and analyses
• Use tools and technology to track and report on requests
• Partner with teams across the organization to support end user needs

Technical Specialist – Healthcare

Program Manager

• Develop, implement, and complete tactical project plans related to customer issue resolution, quality improvement plans, and program enhancements
• Act as the lead relationship manager for assigned accounts, coordinating proactive customer communication
• Lead customers to success by understanding their business needs and proactively aligning Cotiviti's software and services with those needs
• Partner with Account and Product Management on Customer Health, NPS, Executive Business Reviews (EBRs), Expansion, and Renewals
• Forecast and track key metrics, including revenue numbers, member counts, and relevant risk adjustment metrics
• Track and manage product-related issues that impact customer success
• Utilize operational knowledge to recognize revenue and audit regulations for accurate and compliant business practices
• Leverage technical expertise in Encounter submissions and risk adjustment areas to provide valuable insights and support to customers
• Review and analyze support tickets to understand trends and advocate for addressing issues
• Ensure all contracted deliverables are provided according to the contract, on time, and meet expectations

Customer Program Manager

• Work with a high degree of autonomy including independent thinking and responsibility for individual workflow and assignments
• Act as a mentor to all team members within the Business Unit
• May assist with new hire onboarding and training of employees within the Business Unit
• Collaborate with all levels of the business upon assigned projects and deliverables
• Produce knowledge as a Subject Matter Expert (SME) in a multi-functional aspect for auditing as well as business optimization and innovation
• Responsible for a portfolio-wide impact for the entirety of the business units and client partnerships
• Develop and facilitates audit enhancements of new tools to aid in team members’ ability to perform their assigned responsibilities within the databases
• Perform quality control to thoroughly validate submissions prior to Client exportation

Senior Payment Accuracy Specialist, COB

Human Resources

• Review and analyze multi-client impacts, complex member selection, and query construction of data for recoverable Coordination of Benefit claims.
• Work under limited supervision to establish the correct order of liability for client members.
• Input accurate claim recovery information in proprietary Cotiviti software tools.

Payment Accuracy Specialist 1, Coordination of Benefits

• Work under moderate supervision, monitored for efficiency in production and quality
• Build and maintain understanding of CMS and NAIC guidelines
• Utilize Cotiviti audit tools, including Recovery Management System
• Perform audit procedures and identify/define issues
• Collaborate with Engineering to improve tools and reporting
• Achieve standards for productivity and quality in assigned work
• Provide verification of claims validation and respond to inquiries

Payment Accuracy Specialist

• Collaborates with all levels of the business upon assigned projects and deliverables
• Produces knowledge as a Subject Matter Expert (SME) providing knowledge share to Specialists
• Introduces new ideas, research, and creative thinking
• Operates with the distribution of inventory and isolate to designate filters and queries
• Works with multi-clients to produce impact and outcomes
• Has an in-depth understanding of CMS and NAIC guidelines
• Demonstrates advanced level of understanding of query and filter construction
• Utilizes Cotiviti audit tools to complete member investigations
• Creates detail-oriented, accurate notes in Cotiviti audit tools
• Prepares and evaluates responses to client disputes
• Identifies and solves problems by identifying errors and overpayments

Payment Accuracy COB Specialist

Analyst

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement and meet required client turnaround time and KPI goals
• Respond to provider appeals and meet required client turnaround time and KPI goals
• Contribute to product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency
• Become familiar with claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting
• Complete all special projects and other duties as assigned

Clinical Analyst I

Full-stack Engineer

• Lead, direct, and manage the cross-functional technology delivery team.
• Establish and cultivate relationships with business contacts to identify needs & generate and implement solutions.
• Champion engineering and operational excellence, establishing metrics and processes for assessment and improvements.
• Hire, develop, coach, lead and retain top-tier talent.
• Monitor and manage project risks and develop appropriate mitigation plans.
• Administer budgets, timelines, and performance measures to achieve short-term and long-term objectives for the department.

AVP, Software Engineering

Revenue Cycle Specialist

• A Senior Revenue Cycle Specialist 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 Sr. Specialist, Revenue Cycle position is responsible for complex levels of recurring and/or daily functions and processes that are necessary for business execution.
• Other responsibilities will include solving complex issues that have been identified and being a point person for other Revenue Cycle Specialists within the department.
• Analyzes, identifies, and implements procedural change opportunities to improve performance and efficiency, and maximize revenue or margins.
• Works with manager to establish an implementation plan and can work independently or with support of Specialists to implement plan.

Senior Revenue Cycle Specialist

Business Operations

• Identify opportunities for improvement in Current Cotiviti Audit processes
• Help Cotiviti audit teams maximize resources and drive top end revenue and bottom-line margin growth
• Utilize BI tools to enhance and support existing reporting/data warehouse environment, including use of SQL Management Studio, Power BI and Tableau, Excel, MS Access
• Support the Retail/Cotiviti management and other stakeholders in evaluating, defining, standardizing, and reporting on key KPI's to drive financial evaluation and performance
• Manage development lifecycle of report generation (development, test/QA, UAT, bug fix/retest cycles)
• Ensure proper documentation and training materials
• Provide expertise for the design and requirements for both executive and client facing reports, scorecards, and dashboards
• Lead collaborative conversations with client teams to drive stickiness and growth opportunities
• Field and provide support for ad hoc data analysis requests/recommendations from Retail management others on the leadership team
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.

Business Process Optimization Manager

AI Engineer

• The AI Engineer Intern focuses on researching and developing advanced healthcare informatics, particularly in the realm of emerging Artificial General Intelligence.
• Support multiple projects to set up the underlying architecture, such as context layer for data agents, setting up guardrails and governance.
• Communicates technology-related updates and requirements to other departments and contributes to presentations for senior management.
• Collaborates with research and development teams, product management, and strategic analysts to support ongoing projects.
• Partners with Business Units to provide reliable intelligence, validated technology options, and insights on enterprise and industry trends.
• Supports technology project teams by coordinating specific tasks, assisting with day-to-day operations, and contributing to the successful delivery of solutions.
• Completes all responsibilities and goals outlined in the internship program. Complete all special projects and other duties as assigned.

Intern – AI Engineer

Backend Engineer

• Design and develop high quality, maintainable software modules for the Cotiviti, Inc. product suite
• Conduct unit and integration testing using appropriate methodology and techniques
• Analyze requirements and specifications and create detailed designs for implementation
• Analyze and resolve software related issues originated from internal or external customers
• Continuously update professional knowledge of new technologies as selected and integrated into the Cotiviti, Inc. product suite
• Review software engineering approach to proposed solutions to ensure adherence to best practice
• Mentor team members in proper software engineering methods and techniques

Software Engineer – Java, Drools, Bitbucket

Designer

• Implement new policies and update existing policies for clients to ensure the policy is editing in accordance with the industry and per the client’s expectation
• Write and design client requested policies from scratch, translating client expectations into Cotiviti guidelines to ensure appropriate configuration
• Execute projects requests, design work orders, and actively monitor queues to ensure all requests are completed by the desired completion date
• Balance multiple priorities and manage projects deliverables for two or more healthcare clients
• Proactively assist on other client accounts where needed
• Provide the highest level of customer service by documenting and staying current regarding all client sensitivities and configuration needs
• Investigate situations where configuration updates conflict with client customizations or needs
• Meet daily and monthly production and quality targets; maintaining an exemplary level of accuracy in all work; ensuring that the capture and completion of assigned projects are audited and that corrections are made where needed
• Perform regular quality checks to ensure accuracy for all a client’s policy set by analyzing quality reports and troubleshoot results, determining root cause(s) and promptly resolving
• Perform Peer Review responsibilities by providing feedback to peers assisting in achieving department quality goals
• Receive peer feedback, identifying any trends and proposing concise solutions to minimize error rate
• Resolve testing issues and conflicts related to policy configuration updates and policy overlaps
• Analyze pre and post client claim data to ensure appropriate claim editing
• Participate in client presentations by providing configuration expertise and capturing client decisions
• Coordinate and manage post-client presentation activities
• Maintain detailed and up to date knowledge of internal applications, actively participating in all trainings and software release meetings
• Communicate effectively and timely with upstream functional areas to resolve issues

Policy Design Specialist I

Machine Learning Engineer

• Define system architecture for AI/LLM-powered products end to end over claims, medical records, and clinical documentation.
• Build and own evaluation frameworks (LLM-as-a-Judge, offline metrics, online experiments) aligned to accuracy, auditability, and clinical and regulatory risk.
• Drive the data flywheel: convert expert clinician and auditor review decisions into high-quality labeled data.
• Lead ranking and prioritization systems that surface the highest-value claims, audits, and care gaps for human review.
• Establish reusable platform patterns — shared context stores, evaluation harnesses, feature pipelines.

Senior Principal Machine Learning Engineer

Business Development Rep

• Conduct Sales Development activities using the telephone, email, CRM, and other web-based platforms
• Proactively seek new account relationships through an outbound engagement process
• Collaborate with Sales VPs to develop and execute account-level sales strategies
• Qualify prospective customers using solution-selling techniques
• Develop thorough prospect profiles of target accounts
• Participate in sales meetings, pipeline reviews, marketing input sessions and other sales events
• Contribute to a professional atmosphere through positive interaction with customers and co-workers