Senior Technical Specialist – Healthcare

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $85k - $105k / year

⏰ Full Time

🟠 Senior

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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

• Receive business rules from various internal Cotiviti teams • Collaborate with internal partners to clarify rule intent and context • Design and develop rule logic for integration into the Business Rules Management System (BRMS) • Test and validate rules in non-production environments • Implement validated rules into production environments • Communicate rule deployment outcomes and changes to operations and stakeholders • Maintain documentation and version history for business rules • Perform impact analysis for new or revised rules • Conduct root cause analysis and identify gaps in audit or operational results • Recommend and implement corrective actions to improve rule effectiveness • Identify and remediate technical limitations and performance constraints • Lead design and integration of additional exclusions functionality • Partner with operations teams to socialize rules and gather user feedback • Develop reporting and insights on rule effectiveness, audit outcomes, and content trends • Explore automation and workflow enhancements using tools such as Power Automate, JIRA, and Asana • Identify opportunities to transition support, training, or documentation tasks to downstream teams • Complete annual Performance Plan responsibilities and assigned special projects

🎯 Requirements

• High School Diploma required • Bachelor’s degree in education, technical writing, communications, or related fields strongly preferred • Equivalent experience may be considered in lieu of a degree • Experience in the healthcare industry • Basic coding skills and ability to write and understand SQL, Java, or other programming languages • Familiarity with Access, HUE, Datameer, Power BI, or SQL Server Management Studio (SSMS) • Familiarity with complex business rules and products such as DROOLS in RedHat Decision Manager • Experience analyzing large datasets and auditing payment inaccuracies • Ability to work independently and collaborate with others • Excellent analytical and problem-solving skills • Ability to manage multiple assignments while meeting deadlines and quality standards • Excellent organization, communication, and presentation skills • Flexibility to work different shifts as required • Strong working experience with Microsoft Word, Excel, PowerPoint, Visio, and Outlook • Ability to diagnose and solve complex technical issues • Critical-thinking and complex-analysis abilities • Industry-specific knowledge of relevant technologies, systems, or products • Systems-thinking and pattern-recognition abilities • Ability to prioritize technical issues • Empathy, patience, and ability to provide clear explanations when interacting with customers or users • 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 • Must be able to perform duties with or without reasonable accommodation

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance • 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 office setup support requirements