Role Overview:

Support the enhancement and ongoing optimization of claim selection processes and tools, including AI-enabled methodologies.
Focus on applying deep clinical, coding, analytical, and reimbursement expertise to existing selection strategies.
Contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes.

Responsibilities:

Serve as a coding and billing subject matter expert supporting AI and analytics teams.
Partner with data science and analytics teams to validate AI-enabled outputs for clinical accuracy.
Support model and selection logic tuning by reviewing output trends, false positives, and key-metric specific variances.

Qualifications:

Minimum of 5 years of experience in data analytics, medical billing, inpatient and outpatient coding, auditing, or CDI.
Bachelor’s or Graduate degree required.
Mastery of healthcare coding systems and payment methodologies.

Cotiviti

Cotiviti enhances payment accuracy through data-driven solutions. They focus on improving healthcare outcomes and are an equal opportunity employer.