[Hiring] Concept Development Analyst @Cotiviti

Role Description

In the role of Concept Development Analyst (CDA) within our CCV business unit, you will support the enhancement and ongoing optimization of claim selection processes and tools, including AI-enabled methodologies. This role is primarily focused on applying deep clinical, coding, analytical, and reimbursement expertise to strengthen and operationalize existing selection strategies.

• Contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes.
• Partner closely with AI data scientists, analytics teams, and senior leaders, providing coding guidance, analytical insights, and validation to inform model development, tuning, and output evaluation.
• Support analysis of selection outputs, taking meaningful action based on audit performance trends, and investigating identified variances.
• Ideal for individuals who excel as technical collaborators and are motivated by improving claim selection accuracy through data-driven tools and processes.

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.
• Proficiency in at least one and desire to learn others as needed: Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), Emergency Room, Behavioral Health.
• Proficiency in Microsoft Excel required; able to navigate pivot tables and create basic formulas (e.g., Vlookup).
• Mastery of healthcare coding systems and payment methodologies (CPT, HCPCS, ICD-10, HIPPS, and Revenue Codes, etc.).
• AAPC or AHIMA coding certification preferred.
• Proficient with healthcare claim adjudication standards and procedures.
• Excellent verbal and written communication skills.
• Strong analytical and investigative skills.
• Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements.
• Ability to work independently, prioritize tasks, and document progress.
• Prior auditing or consulting experience in either a provider or payer environment is desirable.
• Experience using AI-enabled tools (e.g., ChatGPT, Copilot, or similar) preferred.
• Demonstrated curiosity, comfort working with ambiguity, and interest in experimenting with new analytical approaches or tools.

Requirements

• 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.
• Support model and selection logic tuning by reviewing output trends.
• Identify data quality limitations, coding nuances, or reimbursement considerations.
• Collaborate with stakeholders to ensure selection methodologies align with operational workflows.
• Lead the exploration and execution of pioneering concepts across healthcare provider settings.
• Educate and train Audit Operations leaders and Medical Directors on identified audit opportunities.
• Monitor and update concept criteria and logic to reflect changes in legislation.
• Review all concepts before and after client approval.
• Utilize internal and external tools to evaluate, document, and validate new ideas.
• Complete all responsibilities as outlined in the annual performance review.

Benefits

• Base compensation ranges from $95,000 to $121,000 per year.
• Eligible for discretionary bonus consideration.
• Competitive benefits package including medical, dental, vision, disability, and life insurance coverage.
• 401(k) savings plans.
• Paid family leave.
• 9 paid holidays per year.
• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service.