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Cotiviti
Cotiviti
28 open remote positions
Cotiviti is a healthcare analytics company that provides data-driven solutions to improve financial and clinical outcomes. The company, with thousands of employees, fosters a culture of innovation and collaboration.
Salary Distribution
25 of 28 jobs
PTO Distribution
25 of 28 jobs
Benefits Overview
26 of 28 jobs
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Open Positions
Develop and maintain recruitment dashboards and hiring metrics. Analyze key TA performance indicators such as time-to-fill, cost-per-hire, and source effectiveness. Serve as primary administrator for ATS platforms and optimize recruitment operations.
Data Analytics
Excel
Stakeholder Management
Identify opportunities for improvement in current audit processes and help maximize revenue and margin growth. Utilize BI tools like Power BI, Tableau, and SQL to support reporting and data analysis. Lead collaborative conversations with client teams to drive growth and provide ad hoc data analysis support.
SQL
Power BI
Tableau
Data Analysis
Design and develop high quality, maintainable software modules with unit and integration testing. Leverage AI-enabled tools to improve productivity and elevate quality across all areas of responsibility. Collaborate effectively with Senior Developers, QA, Product Owners, and Project Management.
Java
SQL
Software Development
Data Processing
Healthcare
Design, implement, and maintain privileged access solutions to secure critical systems and accounts. Administer Delinea PAM operations, including integration with enterprise identity and security tooling. Troubleshoot and resolve PAM issues, ensuring compliance and audit readiness.
Active Directory
PowerShell
Azure
CISSP
Analyze claim selection processes and AI-enabled methodologies to optimize payment integrity outcomes. Collaborate with data scientists and analytics teams to validate coding and reimbursement accuracy. Serve as subject matter expert in healthcare billing, coding, and regulatory compliance.
Data Analytics
Medical Coding
Excel
AI Tools
Manage client medical payment policies to ensure accuracy and compliance with CMS and payer guidelines. Conduct periodic reviews and analyses of policy updates, coordinating with Medical Directors and presenting recommendations to clients. Serve as the primary client liaison, addressing inquiries and maintaining detailed documentation of policy nuances.
Clinical Coding
Healthcare Claims
Data Analysis
Project Management
Own the end-to-end product development lifecycle, including discovery, roadmap planning, feature definition, and release execution. Lead product initiatives focused on healthcare enrollment, such as ingestion, validation, transformation, and reconciliation. Gather and document product requirements, translating business and regulatory needs into clear user stories and specifications.
Product Management
Agile
Stakeholder Management
Manage the completion of RFPs from proofing to adhering to due dates. Facilitate kickoff meetings, set timelines, and ensure compliance with client deadlines. Collaborate with departments to maintain up-to-date content and support proposal tracking tools.
Project Management
Written Communication
Editing
Analytical Skills
Healthcare Industry Knowledge
Audit outpatient and specialty claims to ensure coding accuracy, clinical validity, and medical necessity. Utilize advanced coding knowledge and audit tools to identify billing issues and document findings. Meet productivity and quality standards while recommending process improvements and new claim types.
CPC
CCS
ICD-10
CPT
Performs clinical quality assurance review of daily clinical validation reviews and communicates differing audit decisions to ensure accuracy. Integrates healthcare auditing principles and uses industry knowledge to substantiate decisions, reviewing medical records and applying clinical criteria. Serves as a mentor to other QA auditors and may flex into initial audit or appeals roles as needed.
Coding Certification
Microsoft Office Suite
Quality Assurance
Define architectural standards and best practices for workflow platforms, leveraging AI tools to accelerate solution design and code generation. Design scalable and secure workflow solutions aligned to business needs, integrating open-source engines and Java-based ecosystems. Contribute to a Workflow Center of Excellence, driving governance and AI-native standards while collaborating with cross-functional teams.
Java
AWS
AI-assisted Development
Develop and manage tactical project plans for customer issue resolution and program enhancements. Act as the lead relationship manager, coordinating proactive communication and aligning Cotiviti's solutions with client needs. Forecast and track key metrics including revenue, member counts, and risk adjustment, while managing product-related issues.
SaaS
Claims Processing
Risk Adjustment
SQL
Jira
Evaluate strategic acquisitions and investment opportunities for Cotiviti. Conduct financial modeling, valuation, and due diligence for M&A transactions. Collaborate with cross-functional teams and senior leaders to execute complex projects.
Financial Modeling
M&A
Due Diligence
Excel
PowerPoint
Act as a subject matter expert on medical payment policy, analyzing client data and presenting new policy opportunities to health plans. Collaborate with Client Medical Directors and internal teams to develop and advocate for adoption of medical policies that maximize value. Prepare presentations, coordinate reviews, and inspire trust as a trusted advisor for the Health Plan's medical payment strategy.
Medical Coding
Presentation Skills
Data Analysis
Microsoft Office
Partner with business stakeholders to gather and refine functional and technical requirements. Analyze system usage and performance trends to recommend optimizations. Coordinate user acceptance testing and validate implemented solutions.
SQL
Agile
APIs
Documentation
Communication
Defines and drives architecture for an assigned business area, translating strategy into implementable solutions. Designs AI-native systems with guardrails for safe, effective use of AI within applications and workflows. Leads technical governance, mentorship, and cross-functional collaboration to ensure architecture is realized in code.
Java
Golang
Spring
Microservices
Cloud-native
Interpret and assess payment policy and medical coding guidelines to maintain and develop the medical policy library. Conduct thorough research and multi-faceted analytics to identify opportunities and ensure policy accuracy. Collaborate with client-facing teams and internal stakeholders to educate on policy updates and drive quality.
Healthcare Analytics
Claims Adjudication
Data Analysis
Leadership
Apply deep clinical, coding, and reimbursement expertise to enhance AI-enabled claim selection tools. Partner with data science teams to validate AI outputs and improve model performance. Serve as a coding subject matter expert to support audit concept development and optimization.
Data Analytics
Medical Billing
Coding
Excel
Audit
Create, maintain, and execute SQL scripts for data management and validation. Perform data analysis and troubleshoot issues with engineering teams. Adhere to compliance regulations and maintain data integrity.
SQL
PL/SQL
Data Analysis
JIRA
Healthcare
Lead Cotiviti’s pricing strategy, including maintaining existing pricing and creating models for new solutions. Collaborate with senior leaders across the organization to align on priorities and communicate progress. Define KPIs and dashboards to track pricing effectiveness and impact on business performance.
Pricing Strategy
Data Analysis
Executive Communication
Cross-functional Collaboration
Healthcare
Provide legal counsel on government and commercial contracting matters, focusing on federal and state healthcare programs. Draft, review, and negotiate complex agreements including master services agreements and statements of work. Advise internal stakeholders on regulatory risks and support compliance with applicable laws and regulations.
Contract Negotiation
Government Contracting
Legal Research
Compliance
You perform detailed contract compliance audits on construction projects, focusing on AIA billing, GMP/CMAR contracts, and cost control. You validate billed costs, identify recoveries, and ensure compliance with contract terms and industry standards. You communicate audit findings clearly, mentor other auditors, and manage multiple engagements with strong project management skills.
Contract Compliance
Project Management
Cost Control
Design and implement scalable agentic solutions for diverse use cases. Build and maintain a centralized AI platform with unified APIs for cross-functional team access. Lead technical discussions, mentor junior engineers, and set the technical vision for the AI platform roadmap.
Python
LangChain
Kubernetes
AWS
MLflow
Develop and implement comprehensive event strategies aligned with business goals, including tradeshows, client programs, and executive engagements. Lead end-to-end event planning, logistics, and on-site operations, ensuring premium, on-brand attendee experiences. Manage budgets, vendor relationships, and cross-functional collaboration to deliver measurable impact and pipeline generation.
Event Planning
Project Management
Budget Management
Communication
Healthcare
Serve as the primary client contact and trusted advisor, managing relationships and ensuring client success with Cotiviti's PPM/CV products. Coordinate cross-functional teams to execute client strategic plans, monitor program performance, and identify growth opportunities. Manage operational implementation of client payment policy decisions and provide training to optimize program performance.
Client Relationship Management
Healthcare Operations
Project Management
Microsoft Office
Communication
Perform daily audits on client data for completeness and accuracy of coding using clinical knowledge. Respond to provider appeals and meet client turnaround time and KPI goals. Utilize coding validation training to become familiar with claims payment policies and regulations.
Registered Nurse
Coding Certification
Medical Coding
Claims Processing
Microsoft Office
Responsible for improving technical effectiveness by planning, developing, and delivering technical training, mentoring, and assessment. Works with subject matter experts to validate workflows and enhance audit productivity, performance, and client satisfaction. Requires 5 to 7+ years of experience with InterQual/MCG criteria and a background in Utilization Management and/or Case Management.
Presentation Skills
Partner with stakeholders to translate strategic priorities into well-defined solution requirements and process designs. Elicit, document, and validate business requirements, maintaining traceability from concept through deployment. Support product roadmaps, backlog prioritization, and agile delivery to ensure solutions solve real client pain points.
Business Analysis
Requirements Gathering
Process Modeling
Agile
SQL