Cotiviti

Sales

• Serve as a senior strategic individual contributor responsible for driving new sales growth within Cotiviti’s National Accounts segment through disciplined account planning, territory strategy, and execution against quota objectives
• Identify, prioritize, and advance enterprise health plan opportunities by expanding executive relationships and building and converting strategic pipeline
• Lead complex, multi-stakeholder sales pursuits from prospecting through negotiation, contracting, and close
• Build and maintain trusted relationships with Health Plan C-suite executives, business owners, procurement leaders, and functional decision-makers
• Orchestrate cross-functional resources across product, marketing, consulting, legal, finance, implementation, and executive leadership to advance strategic enterprise opportunities
• Develop compelling value propositions and solution positioning tailored to National Accounts priorities across Cotiviti’s full Healthcare portfolio
• Maintain rigorous pipeline, opportunity, and forecast discipline, and provide sales leadership with clear visibility into deal progression, risk, and growth potential
• Monitor market trends, competitive activity, pricing dynamics, and customer priorities to inform go-to-market strategy and account pursuit plans
• Represent Cotiviti in client meetings, industry events, and conferences to elevate executive market visibility and generate new business opportunities
• Complete all responsibilities outlined in the annual Performance Plan and perform other duties or special projects as assigned

Sales VP – National Accounts

Auditor

• Generate and Develop New Audit Concepts - Utilizes retail and auditing experience to perform audit procedures that include analyzing, identifying and defining issues, developing criteria, reviewing and analyzing evidence with the intent to audit standard medium - complex reports.
• Leader in concept development across multiple audit verticals.
• Develops New Tools and Processes - Collaborates with Business Optimization and audit team in developing new tools and reports.
• Direct Ownership for Quality Control - Reviews all level auditor claims prior to and after client submission.
• Prepare Response to Client Disputes - Provide oversight to audit team for verification of claims validation in concise written or oral manner.
• Review Client Transactions - Demonstrates high level of expertise in reviewing transaction types, client contracts/vendor agreements, and client data with minimal supervision of how to identify potential over/under payments.
• Participate in knowledge sharing with audit, region, & division.

Senior Auditor, Temporary, Part Time

Content Marketing Manager

• Provide leadership to the team by communicating all expectations and ensuring alignment with Cotiviti’s long-term objectives
• Motivate employees through individual, team, and department recognition
• Recruit and hire new staff, manage existing staff, and develop and implement training and orientation programs
• Ensure goals and standards are consistently met, removing roadblocks to exceptional performance
• Monitor team coverage of responsibilities and ensure accountability.
• Lead all efforts with new products, collaborating with Product Managers to ensure success
• Optimize business tools to support innovation and optimize coding-based content
• Foster an environment of innovation and document standard operating procedures

Manager, Audit Content

• Provide coding and industry expertise to help create and maintain clinical coding edits
• Responsible for writing business logic for new rules and enhancements by translating industry references into Cotiviti policy
• Reviews and identifies changes to medical policies in order to maintain an accurate and current medical policy library
• Work with the client teams to provide coding and clinical expertise for customer and provider inquiries, questions, challenges, or appeals to clinical rules
• Assumes full ownership and accountability for assigned medical policies
• Performs multi-faceted analytics for data and report analysis with minimal direction
• Mentor and train new staff
• Performs QA of policy reviews, logic revisions, and research requests performed by others to ensure accuracy
• Maintains current knowledge-base of industry and Cotiviti content, best practices, applications, procedures, and policies

Content Analyst II

IT Support

• Efficiently and professionally handle daily administrative activities within the COB and DM departments
• Collaborate with all levels and members of the COB & DM auditing team
• Communicates directly with Medicare, Insurance companies, Providers, and/or Employer groups
• Enters accurate member, group, and claim information into Cotiviti tools
• Ensures confidentiality and security of all data, adhering to HIPAA laws and regulations
• Meet or exceeds standards for productivity and quality as identified by guidelines

Audit Support Assistant, Healthcare

Account Executive

• Understand the Cotiviti solution artifacts and prepare client facing presentations based on use cases.
• Perform research on solutions within health plans to build landscape diagram.
• Provide pre-sales, RFP and demo support to solution consultants for Cotiviti solutions.
• Create solution handover document for professional services team during pre-sales process.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.

Temporary Intern – Associate Sales Consultant

Manager

• 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.

Retail Manager

Security Engineer

• Build, implement, and provide tier 2 support for security tools including: WAF, NextGen AV, IPS/IDS, SIEM, DLP, email security gateway, vulnerability management
• Operationalizing existing security tools through control validation/improvements, new feature enablement, and upgrades
• Collaboration with InfoSec & IT team members
• Responding to and investigating escalated security incidents
• Identifying unauthorized access or processes, containing, and eradicating them
• Perform root cause analysis of outage or performance issues that may be related to security tools
• Provide recommendations to stakeholders on the best course of action to remedy the problem
• Participate in on-call rotation for urgent support issues
• Promoting security awareness and cultivating employees into “Security Champions”

Information Security Engineer

Analyst

• Perform daily audits on client data for completeness and accuracy of coding utilizing coding background to ensure appropriateness for reimbursement
• Does not interpret or evaluate medically necessary clinical information but performs duties according to structured algorithms or other written guidelines
• Only licensed personnel provide oversight and follow-up for clinical related questions or issues such as the use of the algorithms or structured guidelines
• State Licensure (renew license, submit new applications, respond to attestations, other special requests)
• URAC (renew accreditation when due, responds to all special requests)
• Train Dental New Hires
• Audit New Hires 100%
• Train/Assist training clients on Nucleus
• Train on Client Imaging systems
• Monthly Quality Audit of Analyst
• May provide leadership, coaching, and/or mentoring to a subordinate group
• May act as a lead or first-level supervisor
• Respond to provider appeals of non-clinical issues
• Respond to client logics and record reviews of non-clinical issues
• Assess and respond to client/provider educational needs, which include providing explanation of coding rationale with little assistance
• Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations
• Contribute to DCA by providing feedback to the Management and Development team on changes to enhance the editing and efficiency as well as passing on client feedback
• Participates on the Quality Committee as required
• Mentor other analysts in learning the rules, guidelines of coding, and the application of company policies and procedures for claim review, appeals, pre-authorizations, and logics
• Complete all responsibilities as outlined in the annual performance review and/or goal setting
• Exceeds all Dental Claims Accuracy department yearly goals
• Complete all special projects and other duties as assigned
• Must be able to perform duties with or without reasonable accommodation

Dental Analyst III – Part-time

Recruitment

• Act as a partner, consultant, and advisor to management
• Develop and drive strategies to recruit talent
• Source, screen, and interview candidates
• Ensure an impressive candidate experience
• Consult with candidates on navigating the interview process
• Track metrics and use data for strategic analysis

Senior Recruiter

Director

• Act as a knowledgebase expert regarding the Cotiviti Medical Policy library
• Gain an understanding of each client’s unique lines of business, medical policy standards and system configuration strategy to inform optimization opportunities
• Analyze client data and identify new medical policy opportunities for presentation including valuation and validation of editing
• Examine and select specific claim examples to utilize in a presentation to the client to support the understanding of the new medical policy
• Prepare various documents and presentation materials for use during internal payment policy committee meetings and/or client meetings
• Review all documents and coordinate reviews with the CMD to evaluate and validate the editing and financial impact
• Confidently perform client policy presentations to highlight the facts of each rule, the data that supports the policy recommendation, the impact to claims processing, and the associated value
• Successfully advocate for the adoption of new medical policies by clients to optimize the value Cotiviti offers
• Participate in client meetings as required as a medical policy subject matter expert
• Coordinate with the internal client team to ensure that all requested follow-up items are delivered to the client
• Inspire trust and credibility with clients
• Communicate effectively across various organizational levels and members of the internal and external client teams
• Assist in identifying opportunities for other Cotiviti product solutions
• Complete all responsibilities as outlined in the annual performance review and/or goal setting
• Complete all special projects and other duties as assigned

Medical Policy Director

Vice President

• Develop, foster, and maintain relationships with customer accounts.
• Liaison between company and client or prospect.
• Serves as the client’s advocate, monitoring and supporting all activity and managing problem resolution.
• Responsible for managing, tracking, and closing all client issues.
• Ensure effective communication with clients regarding new edits and system issues and upgrades.
• Review client data to manage and monitor edit savings and identify potential problems.
• Enter and maintain assigned customer records in the Customer Relationship Management (CRM) database as required.
• Travel to clients and prospective clients to strategically manage client relationships.

VP Client Engagement

• Audits Outpatient and Specialty Claims: Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with Outpatient (APC, PNPP), Pharmacy and/or Inpatient DRG claims.
• Draws on advanced coding expertise and industry knowledge to substantiate conclusions.
• Performs work independently, reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues.
• Effectively Utilizes Audit Tools: Utilizes advanced proficiency, Cotiviti encoder and audit tools required to perform duties.
• Meets or Exceeds Standards/Guidelines for Quality: A chieves the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation.
• Identifies New Claim Types: Identifies potential claims outside of the concept where additional recoveries may be available.
• Recommends New Concepts and Processes: Has broad in-depth knowledge of client, contract terms and complex claim types gained from extensive healthcare auditing experience.
• Suggests, develops and implements new ideas, approaches and/or technological improvements that will support and enhance audit production, communication and client satisfaction.

Auditor, Clinical Validation, Outpatient Specialty

• Focus on auditing Coding & Clinical Chart Validation for Outpatient and Specialty audits
• Audits Outpatient and Specialty Claims using medical chart coding principles
• Utilizes advanced proficiency in Cotiviti encoder and audit tools for duties
• Maintains productivity, accuracy, and quality standards for auditing
• Identifies potential claims for additional recoveries and suggests process improvements
• Completes all responsibilities outlined in the annual Performance Plan

Auditor, Clinical Validation, OPSP Coding

• Serve as a coding and billing subject matter expert supporting AI and analytics teams by providing clinical, coding, and reimbursement guidance to inform model logic, features, and outcomes.
• Partner with data science and analytics teams to validate AI-enabled outputs for clinical accuracy, coding integrity, and reimbursement appropriateness.
• Support model and selection logic tuning by reviewing output trends, false positives, edge cases, and key-metric specific variances.
• Identify data quality limitations, coding nuances, or reimbursement considerations that may impact selection performance and model results.
• Collaborate with stakeholders to ensure selection methodologies align with operational workflows and real world audit execution.
• Lead the exploration, generation, and execution of pioneering concepts across various healthcare provider settings by leveraging your in-depth insights into healthcare billing and coding practices, clinical insights, and regulatory knowledge.
• Support the exploration, enhancement, and execution of audit concepts across healthcare provider settings by applying clinical, coding, and regulatory expertise.
• Identify and implement coding and billing logic development opportunities.
• Utilize healthcare and auditing experience to investigate, identify and define coding and/or billing issues.
• Determine audit procedures, selection methods for identified audit opportunities.
• Collaborate with engineering, analytics, audit teams, client management, and senior concept development team members to obtain alignment and drive results.
• Educate and train Audit Operations leaders and Medical Directors on identified audit opportunities, if needed.
• Communicate results effectively with senior team members and managers.
• Demonstrate proficiency with Medicare reimbursement methodologies, coding and billing guidelines and applicable industry-based standards.
• Monitor and update concept criteria and logic to reflect any changes in legislation, coding rules, and policies.
• Foster and implement new ideas, approaches, and technological improvements to support and enhance audit production, communication and client satisfaction.
• Review all concepts before and after client approval.
• Create and maintain concept validation procedures including scheduled validation of all concepts, monitoring concept performance, and reviewing associated documentation.
• Utilize internal and external tools, including AI-enabled platforms, to evaluate, document, and validate new ideas, claims, and concept effectiveness.
• Ensure new and existing concepts achieve desired goals in terms of recoveries, collectability and client acceptance.
• Apply a curious, analytical mindset to evaluate imperfect or evolving data and translate findings into actionable insights that strengthen existing selection logic and audit concepts.
• Explore and experiment with new approaches, tools, and technologies (including AI-enabled solutions where appropriate) to enhance concept performance and efficiency.
• Demonstrate a strong focus on outcomes and business impact, aligning concept development efforts with measurable results.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned. Must be able to perform duties with or without reasonable accommodation.