Concept Development Analyst; Automated Concepts
Listed on 2026-06-09
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IT/Tech
Data Analyst, Data Security
Concept Development Analyst (Automated Concepts)
Job Location:
US-Remote
Job :
Category:
Audit - Healthcare
Position Type:
Full-Time
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.
Leveraging your knowledge of inpatient billing, you will contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes. Your understanding of healthcare payment methodologies, coding behavior, and reimbursement rules is essential to ensuring selection methodologies align with real‑world audit and billing practices.
As the coding subject matter expert, you will 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. While this role may occasionally support the identification of new audit opportunities, its primary focus is on enabling model performance and selection effectiveness, rather than leading independent concept development.
This position supports analysis of selection outputs, taking meaningful action based on audit performance trends, and investigating identified variances. The role is well suited for individuals who excel as technical collaborators, prefer working as trusted SMEs in the development of AI-powered tools, and are motivated by improving claim selection accuracy through data‑driven tools and processes.
Cotiviti is seeking an experienced Concept Development Analyst (CDA) to support and advance automated, data‑driven audit strategies across Medicare and Government programs. This role is ideal for a billing, coding, and reimbursement expert who thrives in analytical environments and wants to apply their expertise to work closely with AI data scientists and analytics teams to inform and tune model logic and feature design to ensure selection methodologies align with real‑world audit and billing practices.
In this role, you will help design, validate, and optimize automated audit concepts that identify claim selections targeting improper payments using claims data only. Your work directly influences scalable, compliant payment integrity outcomes across inpatient, outpatient, and professional services.
As a CDA, your understanding of healthcare payment methodologies, Medicare regulatory policy, coding standards and behavior, and reimbursement rules is essential to validation of automated selection methodologies and outputs ensuring compliance with billing and coding accuracy, reimbursement appropriateness, and regulatory alignment. As a trusted subject matter expert, you will leverage new technologies that target emerging coding and billing risks suitable for automated detection, advise senior leaders and audit operations, analyze performance trends, false positives, edge cases, and translate findings into actionable improvements.
Responsibilities- Serve as a coding and billing subject matter expert supporting AI and analytics teams by providing clinical, coding, and reimbursement guidance to inform model logic, features, and outcomes.
- Partner with data science and analytics teams to validate AI-enabled outputs for clinical accuracy, coding integrity, and reimbursement appropriateness.
- Support model and selection logic tuning by reviewing output trends, false positives, edge cases, and key metric specific variances.
- Identify data quality limitations, coding nuances, or reimbursement considerations that may impact selection performance and model results.
- Collaborate with stakeholders to ensure selection methodologies align with operational workflows and real‑world audit execution.
- Lead the exploration, generation, and execution of pioneering concepts across various healthcare provider settings by leveraging in-depth insights into healthcare billing and coding…
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