Cotiviti

Auditor

• Audit outpatient and specialty claims, including APC, PNPP, pharmacy, and/or inpatient DRG claims
• Perform coding and clinical chart validation for outpatient and specialty audits
• Review and interpret medical records to identify billing and coding issues
• Assess clinical review, coding accuracy, medical necessity, treatment setting, and services delivered
• Apply medical chart coding principles and client-specific guidelines
• Use Cotiviti Encoder and audit tools
• Enter claims accurately into the Cotiviti system
• Meet productivity, accuracy, quality, and valid claim identification/documentation standards
• Identify potential claims outside the assigned audit concept where additional recoveries may be available
• Suggest and develop audit concepts, process improvements, tools, and technological improvements
• Implement ideas and approaches supporting audit production, communication, and client satisfaction
• Evaluate information and draw logical conclusions
• Complete responsibilities in the annual Performance Plan and special projects or other assigned duties

Auditor, Clinical Validation – Outpatient Specialty

Team Lead

• Train, lead, coach, develop, and retain Revenue Cycle Specialists
• Provide daily oversight of Revenue Cycle Specialists and distribute team work
• Refine Revenue Cycle processes and share knowledge
• Communicate daily with clients and Claim Audit personnel
• Handle projects assigned by the Manager and/or Senior Leadership
• Ensure operational controls and day-to-day Revenue Cycle processes are in place, including cash application, invoicing, reconciliations, and audit controls
• Monitor adherence to internal and external Service Letter Agreements
• Respond to internal and external client inquiries
• Delegate work and collaborate on new-hire materials and departmental training guides
• Analyze revenue streams and revenue-related data to optimize financial performance and drive growth
• Recommend changes to product/service pricing based on availability and expected demand
• Modify revenue management strategies to reach targeted markets
• Monitor team efficiency and ensure output meets expectations
• Implement and administer organizational functions and processes accurately, on time, and in compliance with policies and regulations
• Plan, schedule, and coordinate Revenue Cycle Team work with the Manager, Revenue Cycle
• Use metrics to monitor departmental activities and compliance with client and company guidelines
• Supervise personnel, client requests, Revenue Cycle workflows, and systems
• Serve as team leader and escalation path for complex inquiries and problem resolution
• Support selection, supervision, evaluation, development, performance management, progression, and compensation actions for the team
• Set objectives and conduct performance reviews for direct reports
• Ensure staff training, education, career progression, and required certifications are maintained
• Promote knowledge sharing through best practices, benchmarking, whitepapers, and tool enhancements
• Recommend system and process improvements to increase productivity and cost containment
• Complete annual performance plan responsibilities, special projects, and other assigned duties

Team Lead, Revenue Cycle

Revenue Cycle Specialist

• Reconcile and post all payments received
• Identify discrepancies and analyze issues to ensure timely payment posting
• Manage inventory and system alignment between Cotiviti and clients
• Reconcile data between different sources
• Post payments to collection accounts and reconcile them with posted bank transactions
• Coordinate with the AP department to issue refunds when needed
• Reconcile monthly bank statements with the cash posting database
• Post adjustment transactions to collection and client systems
• Perform cash application functions according to corporate and client requirements
• Access and interpret online systems to determine claim payments and accurately apply payments and adjustments
• Assist in determining the adjudication of refunds
• Prepare and record financial transactions for assigned accounts
• Ensure daily deposit reconciliation and maintain daily and monthly audit reporting
• Review and correct discrepancies in daily deposit totals
• Balance and reconcile bank deposits and communicate with internal and external customers
• Research and accurately distribute payments lacking invoice numbers or dates of service
• Identify the correct claim for payments using patient and date-of-service information
• Maintain knowledge of compliance and recovery laws regarding processing and recoupment
• Work with cross-functional teams

Vice President

• Own and execute Cotiviti’s market strategy, product roadmap, and commercial growth for health plan interoperability
• Expand Cotiviti’s impact into broader payer/provider collaboration
• Prioritize market needs, run competitive analysis, and engage internal and external experts
• Lead product launches that expand client value and advance Cotiviti’s market position
• Own product vision, definition, packaging, and market success across the interoperability platform and commercial solutions
• Lead a matrixed, multi-level team delivering next-generation payer/provider collaboration solutions
• Ensure Cotiviti product offerings are FHIR native and leverage the Interoperability Platform
• Provide input into strategic plans across business units
• Collaborate with executive leadership on annual bookings, revenue, expenses, and client satisfaction targets
• Serve as voice of the customer in product management and development
• Develop multi-year roadmaps for the payer/provider collaboration journey
• Provide executive leadership for interoperability strategy, operations, revenue growth, client outcomes, and business expansion
• Represent Cotiviti with key clients, strategic partners, regulators, industry consortiums, and market influencers
• Drive AI- and emerging-technology-enabled process re-engineering
• Own business performance, revenue growth, operating margin, investment prioritization, and long-range financial planning
• Ensure products and operational workflows comply with state and federal regulations
• Lead multidisciplinary organizations across Product Management, Product Operations, Market Strategy, and Product Commercialization
• Lead cross-functional Product, Marketing, Sales, Business Unit Operations, and R&D teams in developing and launching solution enhancements
• Align delivery with SAFe Agile and related Product Management processes
• Define success criteria and optimize product portfolio performance and competitive position
• Define end-to-end customer experience
• Complete and maintain Ready to Market and Ready to Sell tools, content, and training
• Establish and improve Product Management processes and staffing needs
• Champion product development and product management practices, tools, processes, and skills
• Define and execute three-to-five-year growth strategies, including market expansion, partnerships, acquisitions, and innovation investments
• Develop profitable, efficient, growth-oriented solutions and assist with pricing strategies
• Ensure high-quality releases and track progress through clear metrics
• Hire, develop, coach, lead, and retain top-tier talent
• Complete performance-review responsibilities, special projects, and assigned duties

VP Product Interoperability

Support Engineer

• Provide advanced technical and functional support for Interoperability and Smart Trading products, including Transaction Management and XES
• Serve as technical lead during SEV1 and SEV2 incidents, driving troubleshooting and coordinating resolution across teams
• Investigate and resolve complex production issues
• Perform root cause analysis and recommend preventive measures
• Monitor application health, system performance, and operational stability in production environments
• Collaborate with Engineering, Product Management, Professional Services, and Infrastructure teams to resolve product defects and operational challenges
• Support deployment, configuration, maintenance, and upgrade activities across hosted and on-premises customer environments
• Ensure adherence to incident, problem, and change management processes
• Deliver responsive, high-quality customer support throughout the support-case lifecycle
• Maintain documentation for troubleshooting procedures, known issues, and operational runbooks
• Mentor Support Engineers and junior team members
• Drive continuous improvement in monitoring, automation, operational efficiency, and service quality
• Participate in on-call rotations for business-critical systems operating in a 24x7 environment
• Collaborate with customers and internal stakeholders to understand business processes and provide platform-aligned solutions
• Meet or exceed quality, productivity, customer satisfaction, and service level objectives
• Complete annual performance-review goals, special projects, and other assigned duties

Senior Support Engineer – Interoperability

Product Manager

• Define the product strategy and roadmap
• Deliver product market requirements documents with prioritized features and justifications
• Use AI tools to create product prototypes and requirements
• Monitor and analyze competition
• Develop product positioning and messaging
• Perform product demonstrations for customers
• Collaborate with Marketing to develop sales tools
• Propose an overall budget for product success
• Briefly train the sales force at quarterly sales meetings
• Lead cross-functional collaboration and influence business decisions without direct authority
• Align stakeholders and ensure team consensus to bring products to market
• Commercialize new products to drive market adoption and revenue growth
• Manage the product or product line throughout its lifecycle
• Act as a leader within the company
• Complete special projects and other assigned duties

• Define and communicate the overall product vision, strategy, and roadmap in alignment with company objectives
• Lead, mentor, and scale a product management team, fostering a high-performing and collaborative culture
• Analyze market trends, customer needs, and competitive landscape to drive product innovation and differentiation
• Oversee the end-to-end product lifecycle, from ideation and development through launch and continuous improvements
• Set and measure key product metrics to evaluate success and inform future decisions
• Collaborate with engineering, UX/UI, sales, marketing, and customer success teams
• Serve as the voice of the customer and industry thought leader
• Influence executive leadership and present business cases
• Manage product budgets and timelines
• Identify and mitigate risks
• Hire, develop, coach, lead, and retain top-tier talent
• Complete responsibilities outlined in performance reviews and goals
• Complete special projects and duties as assigned
• Perform duties with or without reasonable accommodation

Senior Director, Product Management

Client Services Representative

• Coordinate the cross-functional client team to achieve client plans, revenue retention, client satisfaction, and growth for Prospective Payment PPM and CV products
• Serve as the primary client contact, trusted advisor, internal and external liaison, and operational subject-matter resource
• Build and sustain client relationships; identify client needs, expanded opportunities, and solutions
• Collaborate with the Go-To-Market team on client strategic plans and lead tactical execution
• Promote policy adoption and acceleration through organization, communication, and project management
• Identify and communicate cross-product opportunities
• Manage operational implementation and execution of client payment policy decisions across Claims Operations, Provider Services, Appeals, Network Operations, Payment Integrity, IT, and other departments
• Coordinate and manage joint client/internal meetings, including scheduling, facilitation, agendas, materials, minutes, action items, and logistics
• Document and distribute meeting minutes and follow up on action items
• Maintain accurate, current client documentation in Cotiviti’s library
• Manage internal and external aspects of client initiatives and joint projects to ensure objectives and milestones are met
• Monitor program performance, analyze monthly reports, identify trends and root causes, and develop and execute corrective action plans
• Provide client testing support for operational and policy initiatives
• Maintain escalation plans and monitor file-processing statistics to minimize missed policy opportunities
• Coordinate production reporting to identify trends and data anomalies; develop and execute recommendations
• Administer customer-service tool user accounts, access, usage, and data accuracy
• Identify client education needs and develop and deliver client training programs
• Manage client inquiries, triage them appropriately, and ensure timely resolution
• Participate as an operational SME in department and corporate projects
• Travel up to 20%
• Complete annual performance-review goals, special projects, and other assigned duties

Client Services Manager

• Reconcile and post all payments received
• Identify discrepancies and analyze issues to ensure timely payment posting
• Manage inventory and system alignment between Cotiviti and its clients
• Reconcile data between different sources
• Post payments to collection accounts and reconcile them with posted bank transactions
• Work with the AP department to issue refunds when needed
• Reconcile monthly bank statements with the cash posting database
• Post adjustment transactions to collection and client systems
• Perform cash application functions according to corporate and client requirements
• Access and understand online systems to determine how claims were paid and accurately apply payments and adjustments
• Assist in determining the adjudication of refunds
• Prepare and record financial transactions for assigned accounts
• Ensure daily deposit reconciliation and maintain daily and monthly audit reporting
• Reconcile daily deposit totals, review and correct discrepancies
• Balance and reconcile bank deposits and communicate with internal and external customers
• Research and distribute payments without apparent invoice numbers or dates of service
• Determine the correct claim for payments using valid patient and date-of-service information
• Maintain knowledge of compliance and recovery laws regarding processing and recoupment to ensure compliance with state laws

Data Engineer

• Lead the data engineering team and oversee development of strategic perspectives regarding IT architecture and business needs
• Develop and implement data architecture and engineering strategies leveraging AI
• Develop templates, reference architectures, and patterns for modern data engineering pipelines connecting on-premises and cloud data sources
• Partner with Architecture and Product teams and contribute to data product strategy and data literacy
• Monitor AI trends and apply relevant innovations to improve team efficiency, productivity, and architectural relevance
• Manage internal stakeholders and speak with clients on behalf of the organization as needed
• Evaluate staff performance and support professional development through goal-setting, coaching, assessment, and mentoring
• Make IT decisions for the area of responsibility and optimize service costs using internal and external resources
• Ensure information systems and networks comply with HIPAA, internal standards, accrediting agency standards, regulatory requirements, and legal requirements
• Develop, implement, test, and revise disaster, emergency mode operation, backup, physical security, personnel security, and access plans
• Hire, develop, coach, lead, and retain talent while building a high-performing team and culture
• Complete annual performance review or goal-setting responsibilities and assigned special projects

Manager, Data Engineering – AI

Artificial Intelligence

• Lead high-impact digital transformation and process improvement projects using AI, automation, and analytics, typically delivering seven- to eight-figure financial impact
• Identify, evaluate, and implement AI/ML and intelligent automation solutions to optimize business processes
• Develop and maintain technical process documentation, including process flows, RACI charts, integration diagrams, SOPs, and design artifacts
• Assess organizational readiness, identify change impacts, and execute change management strategies supporting technology and process adoption
• Lead stakeholder engagement through impact assessments, communication planning, training needs analysis, and resistance management
• Conduct process discovery using process mining, value stream mapping, analytics, and interviews
• Provide project leadership for integrations, system implementations, and strategic transformation initiatives
• Coordinate business and technical teams on scope, requirements, timelines, handoffs, and deliverables
• Deliver executive updates on project status, ROI, feasibility, readiness, and adoption metrics
• Adapt process improvement approaches using Lean, Six Sigma, DevOps, or hybrid methods
• Build and maintain process repositories, knowledge assets, dashboards, and continuous-improvement measures
• Support training, mentoring, and certification efforts in process improvement, technical writing, change management, and AI literacy
• Complete annual Performance Plan responsibilities and assigned special projects and duties

Staff AI Process Specialist

Business Operations

• Work in small project teams to identify and address complex business challenges
• Lead consultative requirements-gathering sessions with internal operational stakeholders
• Scope analytical support needs and provide solutions enabling data-driven decision-making and revenue growth
• Conduct sophisticated data analysis, modeling, prescriptive/diagnostic insight generation, and data storytelling across the Retrospective Claims Auditing business
• Lead process optimization exercises to compress reporting/production time and maximize organizational resource utility
• Create automated business tools, templates, and KPI reporting products for operations/yield departments
• Conduct ROI and opportunity-cost evaluations for resource reallocation, capital investments, and new business opportunities
• Assist management with transformational execution of new business practices and operational accountability
• Develop and lead monthly/quarterly business reviews benchmarking departmental financial performance, evaluating cost, and measuring productivity and business health
• Build solutions and insights for competitive intelligence cross-functionally
• Create, deliver, and maintain basic client/internal reporting when necessary
• Complete annual Performance Plan responsibilities and assigned special projects

Senior Business Operations Analyst

Customer Success Manager

• Ensure successful delivery of products and services to Cotiviti clients within the Health Enablement portfolio
• Partner with Client Executives, Product Owners, Operational teams, and cross-functional teams
• Serve as primary liaison for complex or high-visibility client engagements
• Resolve issues independently without requiring leadership escalation
• Produce and manage documents related to client projects, calls, meetings, special initiatives, and follow-up
• Interact directly with client stakeholders to drive satisfaction, retention, and product adoption
• Manage open issues in a timely manner and ensure key milestones are not missed across a complex, multi-client portfolio
• Track and report client SLAs and identify portfolio trends for broader process improvements
• Identify obstacles and proactively coordinate Cotiviti resources to resolve them
• Lead projects and process improvements that streamline program management operations
• Mentor and develop Associate, Program, and Senior Program Managers
• Serve as subject matter expert on selected Health Enablement products and services
• Handle remote project collaboration to execute milestones and tasks
• Complete annual performance review/goal-setting responsibilities and assigned special projects

Principal Program Manager – Customer Success

Data Analyst

• Manage data and data quality
• Host and facilitate discussions with healthcare data carriers to manage data intake and confirm client data requirements
• Document meeting discussions and obtain sign-off from clients and carriers
• Perform data quality checks to verify source data meets requirements for building the Healthcare Data Warehouse
• Write data transformation specifications to load source data into target data warehouse tables
• Work with database programmers to quality-check reformatted coding and transform raw data into table layouts
• Perform data analysis and data mining, and identify issue root causes using SQL
• Assist the Engineering/Tools team with new business requirements and Functional Specifications
• Help convert internal processes from manual to automated through coding and programming
• Complete responsibilities outlined in performance reviews and goal setting
• Complete special projects and other assigned duties
• Perform duties with or without reasonable accommodation

Solutions Engineer

• Build and support integration solutions within the company’s software ecosystem
• Collaborate with clients, business teams, developers, and infrastructure providers to design and implement scalable integrations
• Understand business needs, define technical requirements, and support integration and software solutions
• Act as technical point of contact for client discussions and present design choices
• Design, implement, and maintain integrations connecting internal and external systems
• Support complex software and integration system design in alignment with overall architecture
• Collaborate with product architects on scalable, reusable application architectures
• Provide technical support across development and integration projects
• Evaluate emerging technologies, including Machine Learning and AI, through prototyping and reference implementations
• Present technology findings and recommendations to internal teams and clients
• Create and maintain documentation covering architectures, data flows, and troubleshooting guides
• Complete performance-review responsibilities, special projects, and other assigned duties

Auditor, Clinical Validation – Outpatient Specialty

Team Lead, Revenue Cycle

Revenue Cycle Specialist

VP Product Interoperability

Senior Support Engineer – Interoperability

Product Manager

Senior Director, Product Management

Client Services Manager

Revenue Cycle Specialist

Manager, Data Engineering – AI

Staff AI Process Specialist

Senior Business Operations Analyst

Principal Program Manager – Customer Success

Data Analyst

Associate Integration Solutions Engineer