Support the enhancement and ongoing optimization of claim selection processes and tools.
Apply 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.
Provide coding guidance, analytical insights, and validation to inform model development, tuning, and output evaluation.
Analyze selection outputs and take meaningful action based on audit performance trends.

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 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.
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).

Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance
401(k) retirement plan
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 with Cotiviti

Concept Development Analyst – Automated Concepts

Key skills