KEY RESPONSIBILITIES:

• Primary focus on Data Driven E dit (DDE) development

• Research, build and test edits to be used in the Claims Editing library of edits.

• Use of strong coding and industry knowledge to build edits and editing content (data used by the edits).

• Ensure compliance with HIPAA regulations and requirements.

• Ensure adherence to quality assurance guidelines .

• Serve as a subject matter expert for edits and provide support where needed .

• Work closely with client teams to provide coding expertise for customer and provider inquiries

• Provide written response, documentation and rational e for inquiries as needed.

• Utilize the most up-to-date approved Zelis medical coding sources for edit development while also advising appropriate personnel of important changes , issues, and trends .

• Test and validate changes made to the edit(s) .

• Monitor, research, and summarize trends, coding practices, and regulatory changes.

• Performs other related responsibilities and special projects as assigned.

• Maintains awareness of and ensure adherence to ZELIS standards regarding privacy .

• Partner with other areas to assess and communicate impact to the business for additions, changes, or updates as it relates to edit updates.

  PROFESSIONAL EXPERIENCE:

• 5 + years’ experience healthcare or related industry.

• Current c ertified coder (CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT), or RN, LPN with coding knowledge .

• Proficient in Microsoft Word and PowerPoint .

• Intermediate to Advanced Excel skills preferred.

• Creative problem-solving skills, leveraging insights and input from other parts of an organization while remaining curious

• Consistently demonstrate ability to act and react swiftly to continuous challenges and changes .

• Excellent analytical skills with data and analytics related solutions .

• Excellent communication skills .

• Strong organization and project / process management skills .

• Strong initiative, self-directed and self-motivation .

• Good negotiation, problem solving, planning and decision-making skills .

• Ability to manage projects simultaneously and achieve goals .

• Excellent follow through, attention to detail, and time management skills .

  EDUCATION:

• Graduation or equivalent is mandatory

• Current, active CPC or equivalent credentialing required .

• Bachelor’s Degree Preferred in business, healthcare, or technology preferred.

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

Commitment to Diversity, Equity, Inclusion, and Belonging At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.

As the leading healthcare payments company, we price, pay and explain care for payers, providers, and healthcare consumers. Zelis was founded on a belief there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment because more affordable and transparent care is good for all of us. We partner with over 700 payers, 1.5 million providers, and millions of members -- enabling the healthcare industry to pay for care, with care.Zelis brings adaptive technology, a deeply ingrained service culture, and an integrated pre-payment through payments platform to manage the complete payment process.