Technical Specialist Healthcare - Cotiviti

Overview

The Technical Specialist will collaborate closely with the RCA - Content & Enablement Department, the Implementations Team, and the Audit Operations and R&D teams. This role involves the initial reception and generation of Business Rules, which are crucial for the functioning of RCA’s new platform applications. The Technical Specialist will be tasked with creating the logic for these business rules, ensuring their deployment for operational use, and maintaining comprehensive documentation and impact analysis for each rule. Additionally, the Specialist will act as a key liaison between the operations team and our BRMS Center of Excellence, facilitating effective communication and coordination.

Responsibilities

• Receive business rules from various internal Cotiviti teams.
• Collaborate with internal partners to clarify the intent of each rule.
• Design and develop rule logic for integration into the Business Rules Management System (BRMS).
• Conduct deployment and testing of rules in a test environment to verify accuracy.
• Implement rules into production environments.
• Communicate effectively with operations and key stakeholders following production deployment.
• Maintain and update documentation associated with each rule.
• Produce impact reports and analyses.
• Use tools and technology to track and report on requests.
• Partner with teams across the organization to support end user needs.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Qualifications

• High School Diploma Required.
• Bachelor’s degree in education, technical writing, communications, or related fields strongly preferred. Equivalent experience may be considered in lieu of a degree.

Minimum 3-4 years Cotiviti experience or equivalent within healthcare industry.

Basic Coding Skills: Understanding of basic programming languages and ability to write and understand code in SQL, Java, or other.

Familiarity with tools such as Access, HUE, Datameer, Power BI, or SQL Server Management Studio (SSMS).

Experience with complex business rules: Familiarity with products like DROOLS in RedHat Decision Manager.

Experience in analyzing large datasets and auditing payment inaccuracies.

Ability to work independently, but also to communicate and collaborate with others to meet desired outcomes.

Excellent analytical and problem-solving skills and ability to manage multiple assignments simultaneously while meeting deadlines and quality standards.