Concept Development Analyst – Automated Concepts

🕒 May 13

🇺🇸 United States – Remote

💵 $95k - $121k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 45%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Serve as a coding and billing subject matter expert supporting AI and analytics teams with clinical, coding, and reimbursement guidance • Partner with data science and analytics teams to validate AI-enabled outputs for clinical accuracy, coding integrity, and reimbursement appropriateness • Tune model and selection logic by reviewing output trends, false positives, edge cases, and metric-specific variances • Identify data quality limitations, coding nuances, and reimbursement considerations affecting selection performance • Collaborate with engineering, analytics, audit, client management, and senior concept development teams • Explore, generate, execute, enhance, and validate automated audit concepts across healthcare provider settings • Identify and implement coding and billing logic development opportunities • Investigate and define coding and billing issues and determine audit procedures and selection methods • Educate and train Audit Operations leaders and Medical Directors on audit opportunities as needed • Monitor and update concept criteria and logic for legislative, coding-rule, and policy changes • Review concepts before and after client approval • Create and maintain concept validation procedures, monitor concept performance, and review documentation • Use internal and external tools, including AI-enabled platforms, to evaluate, document, and validate claims and concept effectiveness • Ensure concepts achieve recovery, collectability, and client-acceptance goals • Experiment with new analytical approaches, tools, and technologies to improve concept performance and efficiency • Complete performance-review responsibilities, special projects, and other assigned duties

🎯 Requirements

• Minimum of 5 years of experience in data analytics, medical billing, inpatient and outpatient coding, auditing, or CDI • Bachelor’s or Graduate degree required • Proficiency in at least one of: Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), Emergency Room, Behavioral Health • Microsoft Excel proficiency required, including pivot tables and basic formulas such as VLOOKUP • Ability to conduct basic data analyses independently • Mastery of healthcare coding systems and payment methodologies, including CPT, HCPCS, ICD-10, HIPPS, and Revenue Codes • Proficiency with healthcare claim adjudication standards and procedures • Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements • Ability to work independently, prioritize tasks, and document progress • Excellent verbal and written communication skills • Strong analytical and investigative skills • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance • Ability to perform duties with or without reasonable accommodation

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plan • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on level and length of service • Remote work arrangement • Dedicated secure work area and high-speed internet/office setup required for remote work