Cotiviti

Program Manager

• Lead, coach, and develop a team of project managers, providing regular feedback, performance guidance, and career development support
• Establish clear expectations and accountability for individual and team performance
• Conduct regular 1:1s, performance reviews, and development conversations to support engagement, growth, and retention
• Support talent planning activities, including hiring, onboarding, and succession planning
• Foster a collaborative, inclusive, and high-performing team culture aligned with organizational values
• Provide oversight and direction for complex payment-related programs and initiatives, ensuring alignment with business priorities
• Manage program timelines, risks, dependencies, and resource allocation across the team
• Ensure consistent application of program management standards, tools, and best practices
• Remove obstacles and escalate risks as needed to ensure successful delivery
• Serve as a primary point of contact for senior stakeholders related to assigned programs
• Partner closely with Product, Technology, Operations, and other cross ‑ functional teams to drive program outcomes
• Communicate program status, risks, and achievements effectively to leadership audiences
• Monitor team workload and capacity to ensure balanced resource allocation
• Drive continuous improvement in processes, execution, and delivery quality
• Use data and metrics to evaluate team and program performance and inform decision-making

Senior Manager, Program Management – Payment

Data Engineer

• Create, maintain and execute intermediate to advanced Spark scripts for data management and data validation, and data integration.
• Create, maintain and execute basic to intermediate SQL scripts for data management and data validation.
• Optimize the queries to improve the efficiency of daily tasks.
• Perform data analysis and identify any issues.
• Work with other groups such as Engineering team, DBA, Cloud ops, etc. to troubleshoot and resolve any environmental or network issues that impact your work.
• Extend your support to after – hours or weekends as needed.
• Create and maintain data pipelines as needed.
• Validates the tasks results to ensure that all the requirements are met.
• Adhere to all the industry level and organization level compliance rules and regulations to maintain data integrity.
• Complete individual productivity tracking.
• Complete task assignments using department ticketing system within assigned deadline.
• Achieve organizational and individual goals as identified in performance reviews and goal setting exercises.
• Complete all special projects and other duties as assigned.

Data Engineer, AI

Business Analyst

• Analyze business needs related to healthcare data exchange and interoperability workflows
• Analyze large volumes of raw healthcare data from multiple source systems including flat files, databases and formats (claims, member, provider, clinical, enrollment, financial) to assess structure, relationships, and consistency
• Analyze relationships between data types (e.g., linking members to claims, providers to encounters) to ensure data accuracy and completeness
• Led discovery and integration workshops with stakeholders across providers and payers to define interface specifications and data mappings
• Developed functional and technical requirements for inbound and outbound interfaces i.e. healthcare data (HL7, FHIR, CDA, CCD, X12, etc.) specifications for development and integration teams
• Interpret and document data integrity issues, bad data patterns, missing values, and duplication
• Map and transform healthcare data into standardized formats (HL7 v2, HL7 FHIR, X12 EDI, CCD/C-CDA, proprietary formats)
• Collaborate with internal and external stakeholders to gather data requirements and define technical specifications
• Collaborate with stakeholders to understand business goals, integration needs, and compliance requirements
• Work with integration teams to design streamlined, automated processes for exchanging data between payer, provider, and third-party systems
• Ensure solutions comply with HIPAA, CMS interoperability rules, ONC guidelines, and other regulatory requirements
• Partner with product managers, architects, and developers to ensure interoperability solutions meet business need
• Develop and execute test cases for data transformations and integrations
• Validate that data outputs align with both business rules and technical specifications
• Validate data accuracy and integrity across systems using SQL and data profiling tools
• Assist in root cause analysis and resolution of integration or data quality issues
• Support UAT (User Acceptance Testing) for interoperability solutions and work with QA teams on test planning and validation
• Monitor industry standards and regulations related to health data exchange and contribute to strategy and compliance initiatives
• Assist development team with performance analysis and testing during release cycles for service packs, hot fixes etc.
• Deliver a consistent, responsive and satisfying customer experience with each project
• Mentored junior BA’s and conducted peer review of BRD’s, user stories and test plans

Senior Business Analyst – Healthcare Interoperability

• Work closely with business partners to understand current operations and how current and future systems may improve productivity and quality.
• Conduct analysis to determine the best approach for addressing business problems and opportunities, including process improvements, system enhancements, and improvements to CCV quality.
• Apply and utilize business process modeling methods to ensure business outcome-based deliverables in a way that can be readily used as input to Product Delivery teams and executive decision-making by both line of business and IT partners.
• Facilitate future-state process and visioning sessions with business partners.
• Define measurable process improvement objectives and participate in grooming features sessions.
• In collaboration with the Appeals Manager, define project requirements and actively support the implementation of process improvements.
• Ensure product satisfies the customer/end-user requirements by actively representing the business users in product testing and evaluation through mapping product enhancement to business process change.
• Translate business requirements into use cases and actionable deliverables.
• Work with data teams to improve appeal reporting accuracy and usability.
• Develop dashboards or reporting requirements for leadership.
• Reduce manual steps and rework in appeal processing.
• Improve intake, routing, and adjudication workflows.
• Spot inconsistencies in appeal handling across teams.
• Conduct ad hoc research and support special projects as assigned.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.

Business Analyst I

Auditor

• Analyzes and Audits Claims
• Integrates medical chart severity of illness and intensity of service based on clinical guidelines and objectivity in performance of medical audit activities
• Effectively Utilizes Audit Tools
• Meets or Exceeds Standards/Guidelines for Productivity
• Meets or Exceeds Standards/Guidelines for Accuracy and Quality
• Identifies New Claim Types
• Suggests and develops high quality, high value concept and or process improvement, tools, etc.
• Complete all responsibilities as outlined on annual Performance Plan
• Complete all special projects and other duties as assigned

Auditor Clinical Validation, Place of Service, Short Stay, Readmission

Artificial Intelligence

• Design and run evaluations for LLM-based agents (quality, reliability, safety)
• Analyze agent behavior and identify failure modes
• Propose improvements based on empirical results
• Build and enhance components such as tools, skills, memory systems, and MCP integrations
• Improve orchestration, observability, and developer experience
• Explore approaches combining LLMs with rules, knowledge graphs, or symbolic reasoning
• Work on use cases requiring auditability and explainability (e.g., claims, policy logic)
• Help bridge probabilistic AI with deterministic systems
• Partner closely with internal stakeholders or pilot users
• Rapidly prototype and iterate on solutions in real-world contexts
• Help define patterns for scaling adoption of agentic systems

Temporary Intern – Agentic AI, Neural-Symbolic Systems (Healthcare)

Medical Billing and Coding

• Conduct accurate, compliant, and complete diagnosis code abstraction for Medicare, Commercial, and Medicaid risk‑adjustment programs
• Review medical records for accurate diagnosis code abstraction
• Stay current on coding guidelines by attending required trainings
• Communicate findings, errors, and suggestions to Team Lead

Coder 1 – HCC Risk Adjustment

General Counsel

• Prepare and draft applications and petitions for employment-based immigration cases, including PERM, H-1B, L-1, Blanket L and F visa matters
• Responsible for building strong relationships and partnering with cross-functional partners including recruiting and HR to execute immigration sponsorship assessments in-house
• Advise the business and impacted employees with respect to employment-based immigration matters and visa applications
• Responsible for responding to USCIS and DOL requests for additional information
• Maintain comprehensive knowledge of immigration laws, regulations, and policies
• Advise and consult with management and leadership across the organization to ascertain impacts on business practices, operational costs and efficiencies
• Execute best practices in creation of policies and procedures for all stages of the immigration process, including internal management of immigration caseload
• Analyze cases, determine case strategies, and prepare employees for interviews, hearings and trials
• Correspond with employees during the intake process and maintain regular communication with existing employees regarding active cases
• Track, and maintain highly organized case files via a Case Management Platform, inclusive of forms management
• Complete all responsibilities as outlined in the annual performance review and/or goal setting
• Complete all special projects and other duties as assigned

Immigration Counsel

• Own overall program execution and operational delivery for a strategic client within Cotiviti’s Value-Based Care solutions.
• Partner closely with Client Executives to align delivery execution with client goals, contractual commitments, and long-term growth objectives.
• Act as the primary point of coordination across internal teams including Product Management, Engineering, Data Analytics, Operations, Implementation, and Support to ensure alignment and timely execution.
• Lead client-facing cadence including planning meetings, operational touchpoints, release discussions, issue reviews, and roadmap alignment.
• Proactively identify delivery risks, dependencies, and obstacles; orchestrate appropriate internal resources to resolve issues before they impact clients.
• Ensure open issues, action items, and cross-team dependencies are tracked, communicated, and resolved within agreed timelines.
• Maintain accountability for key milestones, client expectations, and delivery outcomes across concurrent initiatives.
• Track and report on contractual commitments, SLAs, and operational performance.
• Produce and manage client-related documentation including meeting materials, program plans, requirements coordination, decisions, risks, and follow-ups.
• Ensure client delivery activities are managed in alignment with revenue expectations and operational constraints.
• Contribute to continuous improvement of internal delivery processes, tools, and cross-functional workflows.
• Complete annual performance objectives and additional strategic initiatives as assigned.

Senior Program Manager, Value Based Care

Manager

• Monitor, analyze, and communicate federal and state policy developments that impact Cotiviti's business and product portfolio
• Track federal legislation affecting Medicare Advantage, risk adjustment, quality measurement, and healthcare technology
• Prepare executive briefings, policy summaries, and impact assessments for leadership and product teams
• Translate complex policy language into business implications and actionable recommendations
• Provide regular policy updates to Product, Sales, and Executive teams through structured briefings

Policy Intelligence Manager

Support Engineer

• Act as a technical expert for Corporate and Client LMS, SharePoint, CRM, and GTM applications, contributing to optimal configuration, security, and usability.
• Translate complex business requirements into scalable technical solutions, ensuring alignment with enterprise architecture.
• Lead SharePoint technical design, system integrations, and data migrations to enhance platform functionality and efficiency.
• Identify opportunities for automation, process improvements, and enhanced user experiences across global applications.
• Establish and document technical best practices, governance policies, and system standards for global teams.
• Oversee Corporate and Client related LMS and SharePoint system administration, including permission management, security configurations, and performance tuning.
• Troubleshoot complex technical issues, resolve system bottlenecks, and optimize platform performance.
• Conduct data analysis and reporting, providing insights on system utilization, adoption, and efficiency improvements.
• Develop technical documentation, user guides, and support materials to enhance system knowledge across teams.
• Serve as the technical liaison between business teams, IT, and external vendors, ensuring effective communication of technical requirements.
• Provide technical expertise and recommendations to support decision-making on platform enhancements and new implementations.
• Collaborate with cross-functional global teams to drive system improvements and ensure seamless application performance.
• Support user training initiatives, ensuring teams effectively leverage system capabilities.
• Research and evaluate emerging technologies, identifying opportunities for enhanced automation, integration, and digital transformation.
• Implement AI-driven solutions, process automation, and advanced analytics in SharePoint to improve operational efficiency.
• Drive ongoing system enhancements, ensuring applications evolve to meet business needs.
• Lead and support projects and initiatives as assigned by leadership.

LMS & SharePoint Administrator - GTM Technical Analyst

Sales

• Own and execute a new business sales strategy for Cotiviti’s Dental Claim Accuracy solutions within an assigned territory.
• Prospect, qualify, and close new opportunities with Dental Benefit Administrators and Health Plans offering dental benefits.
• Develop and maintain senior-level relationships with: Dental Plan Executives (President, GM, EVP) Dental Operations and Claims Leadership Finance, Network Management, and Policy leaders Procurement and Strategic Sourcing teams.
• Lead complex, multi-stakeholder sales cycles involving: Dental claims accuracy and payment integrity use cases ROI, savings validation, and performance guarantees Software + services contracting models.
• Develop territory and account plans aligned to dental market dynamics, customer priorities, and competitive landscape.
• Collaborate with internal teams (Product, Clinical Dental SMEs, Legal, Implementation) to: Shape solution positioning Support RFPs and procurement processes Deliver compelling value propositions.
• Monitor competitive activity, pricing trends, and market conditions specific to dental payment accuracy and claims auditing.
• Represent Cotiviti at dental payer conferences, industry forums, and executive briefings.
• Maintain accurate pipeline management, forecasting, and opportunity tracking within Cotiviti’s CRM.
• Provide regular updates to sales leadership on: Pipeline health (sufficiency and velocity) Forecast risk Market intelligence and customer feedback.
• Ensure all sales activities align with Cotiviti policies, compliance standards, and contracting guidelines.
• Complete all responsibilities outlined in the annual Performance Plan and other duties as assigned.

Sales VP, Dental Solutions

Implementation Specialist

• Implement and configure Edifecs applications for payer systems on AWS, Azure cloud or virtual machines.
• Implement and manage integrations between Edifecs’ products and solutions and Customer’s on-premise systems.
• Analyze business requirements and translate them into technical configurations, workflows, and mapping documents.
• Develop and test real-time and batch integrations using EDI (X12: 834, 837, 835, 270/271, 276/277, 278), FHIR (CMS Interoperability APIs), HL7 v2/v3.
• Implement service-based integrations via RESTful APIs, SOAP Web Services, ESBs, and iPaaS platforms.
• Create mapping specifications and perform data validation, reconciliation, and error resolution.
• Support ETL processes and legacy data migration to new payer systems.
• Perform data profiling, cleansing, transformation, and loading activities.
• Assist QA teams with creating technical test cases and validating system configurations and interfaces during SIT/UAT.
• Partner with business analysts, SMEs, solution architects, and delivery leads to ensure alignment of technical deliverables.
• Provide post-implementation support during the transition from implementation to maintenance.

Implementation Consultant

• Create, maintain and execute complex SQL queries for data management and data validation.
• Demonstrates subject matter expertise in relation to data mapping, transformations, validations, and ingestion workflows.
• Monitor data processes, analyze data trends and identify anomalies or issues.
• Immediately report issues regarding quality of/or interruption of data processes following standard operating procedures.
• Perform production solutions and services configurations as needed.
• Serve as a change agent to identify organizational improvements and make recommendations to improve business processes.
• Create and maintain SOP documents.
• Train and mentor new members of the team as needed.
• Participate in meetings with clients and/or stakeholders.
• Troubleshoot issues and provide recommendations for remediation.
• Demonstrate sound judgment in selecting methods and techniques for obtaining solutions.
• Completes work as assigned.
• Participate in customer testing, as needed, for new technology or changes to existing.
• Provide after-hours or weekend support as needed.
• Demonstrate an ability to work independently.
• Adhere to all the industry level and organization level compliance rules and regulations to maintain data integrity.
• Complete task assignments using department ticketing/productivity systems within assigned deadline.
• Achieve organizational and individual goals as identified in performance reviews and goal setting exercises.
• Complete all special projects and other duties as assigned.

Senior Data Engineer – AI

• Analyzes and Audits Claims
• Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities
• Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions
• Performs work independently
• Effectively Utilizes Audit Tools
• Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters
• Meets or Exceeds Standards/Guidelines for Productivity
• Maintains production goals set by the audit operations management team
• Meets or Exceed Standards/Guidelines for Accuracy and Quality
• Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing)
• Identifies New Claim Types
• Identifies potential claims outside of the concept where additional recoveries may be available
• Suggests and develops high quality, high value concept and or process improvement, tools, etc.