Senior Technical Specialist (Healthcare)

This role collaborates closely with the RCA - Content & Enablement Department, the Implementations Team, and the Audit Operations and R&D teams to drive the intake, logic development, deployment, and maintenance of Business Rules that support RCA’s platform applications.

Responsibilities

• Receive business rules from various internal Cotiviti teams.
• Collaborate with internal partners to clarify the intent and context of each rule.
• Design and develop rule logic for integration into the Business Rules Management System (BRMS).
• Conduct testing and validation of rules in non-production environments to verify accuracy.
• Implement validated rules into production environments.
• Communicate rule deployment outcomes and changes to operations and key stakeholders.
• Maintain and update documentation and version history for all business rules.
• Perform impact analysis for newly implemented or revised rules.
• Conduct root cause analysis and identify gaps where rules are not delivering intended audit or operational results.
• Recommend and implement corrective actions to improve rule effectiveness and alignment with business goals.
• Identify and remediate technical limitations and performance constraints related to rule processing.
• Lead the design and integration of additional exclusions functionality to improve rule quality and reduce noise.
• Partner closely with operations teams to socialize rules, gather user feedback, and ensure alignment with business workflows.
• Develop reporting and insights on rule effectiveness, audit outcomes, and content trends.
• Explore automation and workflow enhancements, including integration with tools like Power Automate, JIRA, and Asana.
• Identify opportunities to transition operational support, training, or documentation tasks to the appropriate downstream teams (e.g., Production Support, EXACT Training Team).
• Complete all responsibilities as outlined in the annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Perform duties with or without reasonable accommodation.

Requirements

• 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.
• Experience in the 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.
• Excellent organization, communication, and presentation skills.
• Flexible and able to work in different shifts as per the work requirement.
• Strong working experience with Microsoft suite of applications (Word, Excel, PowerPoint, Visio, Outlook).

Mental Requirements

• Troubleshooting: The ability to diagnose and solve complex technical issues, often under pressure.
• Critical Thinking: Assess situations, evaluate possible solutions, and make decisions based on logic and data analysis.
• Complex Analysis: Break down complicated systems or data into manageable parts to analyze and understand them.
• Industry-Specific Knowledge: Deep understanding of specific technologies, systems, or products relevant to the role.
• Systems Thinking: Understand how different components of a system interact and foresee how changes may affect other parts.
• Pattern Recognition: Identify patterns in complex data or recurring problems to develop effective solutions.
• Prioritization: Determine which technical issues are most pressing and need immediate attention in high-pressure environments.
• Empathy and Patience: Listen carefully, understand concerns, and provide solutions considerate of customer needs.
• Clear Explanations: Simplify complex technical issues and present them in an understandable way.

Working Conditions and Physical Requirements

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Pay

Base compensation ranges from $85,000 to $105,000 per year. Specific offers are determined by various factors, including experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Benefits

• 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 with Cotiviti.