[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.
• Support analysis of selection outputs, taking meaningful action based on audit performance trends, and investigating identified variances.
• Help design, validate, and optimize automated audit concepts that identify claim selections targeting improper payments using claims data only.
• Influence scalable, compliant payment-integrity outcomes across inpatient, outpatient, and professional services.
• Leverage new technologies that target emerging coding and billing risks suitable for automated detection.

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: Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), Emergency Room, Behavioral Health.
• Proficiency in Microsoft Excel required; able to conduct basic data analyses independently.
• Mastery of healthcare coding systems and payment methodologies (CPT, HCPCS, ICD-10, HIPPS, and Revenue Codes, etc.).
• AAPC or AHIMA coding certification preferred.
• Excellent verbal and written communication skills.
• Strong analytical and investigative skills.
• Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements.
• 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.

Requirements

• Ability to work independently, prioritize tasks, and document progress.
• Demonstrated curiosity, comfort working with ambiguity, and interest in experimenting with new analytical approaches or tools.
• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

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.