Cotiviti is seeking a Technical Customer Solutions Manager to drive long-term success for healthcare payer clients through effective use of Cotiviti products, addressing operational knowledge of data processing systems, regulatory compliance, and enterprise system integration.
Requirements
- Operational knowledge on processing data through various systems (QNEXT, Health Edge, ZeOmega, etc.), recognizing revenue and audit regulations, and technical expertise in all areas related to Payer Gateways (EDI, FHIR, API)
- 6+ years of technical expertise in claims processing, encounter submissions, and risk adjustment workflows.
- Fluent in Software as a Service (SaaS) distribution models.
- Strong working knowledge of Microsoft Office, Freshdesk, SQL, and Jira.
- Experience with project management and knowledge of standard methodologies like Agile, Waterfall.
- Understanding of the Commercial, Medicare Advantage, Medicaid, ACA lines of business in a Payer organization.
- Familiarity with customer journey mapping and strategic success planning.
Responsibilities
- Develop, implement, and complete tactical project plans related to customer issue resolution, quality improvement plans, and program enhancements.
- Lead customers to success by understanding their business needs and aligning Cotiviti software and services to drive high-impact results.
- Apply deep operational knowledge of CMS regulations and audit frameworks to ensure accurate, compliant processing.
- Leverage expertise in encounter submissions and EDI transactions (834, 837, 835, 270/271) to support client success and issue remediation.
- Analyze client support tickets and product issues to identify systemic trends and advocate for internal resolution.
- Serve as a key conduit for customer enhancement requests through structured feedback loops to Product Management.
- Forecast and track operational metrics including member volumes, encounter throughput, revenue recognition, and submission accuracy.
Other
- Master’s Degree OR a minimum of 6 years of relevant experience.
- Experience in healthcare, preferably on the Payer side of business.
- Solid organizational skills, including attention to detail and multi-tasking abilities.
- Excellent organizational, communication, and interpersonal skills with a client-first approach.
- Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
