Job details
Job type full-time
Full job description
About zelis
Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claimsZelis delivers integrated network analytics, network solutions, payment integrity, electronic payments and claims communications for payers, healthcare providers and consumers in the medical, dental and workers` compensation markets nationwideZelis is backed by parthenon capital partners and bain capital.
Zelis requires proof of covid-19 vaccination upon hire.
Key competencies
The coding validation analyst manages the coding validation queues and is responsible for the clinical coding review of coding validation specific editsThis will include analysis and research of specific coding scenarios as well as assisting in edit ideation and maintaining review guidelines.
Essential functions
Provide in-depth clinical coding analysis of professional and facility claims routed to the coding validation queue based on new or updated edit logic.
Provide in-depth research on coding scenarios.
Communication and a team work approach.
Identify and provide root-cause analysis of edit performance issues.
Advise management if edits are working as intended and support decision with validation data.
Manage relationships with doc retrieval, it, and ops mgmt to ensure tools needed for validation (i.e., claim images) are readily available to ensure completeness of review and research.
Assist in creating and maintaining job aides aimed at promoting consistency in validations and claims workflow process improvements.
Assist in the submission of it requests associated with validations and the enhancement of reports/tools needed to maximize results.
Maintain current industry knowledge of claim edit references including, but not limited to: ama, cms, ncci.
Work closely with manger of coding validation and vice president of edit operations in departmental functions and special projects.
Job requirements
2-5+ years of relevant experience or equivalent combination of education & work within healthcare payers/claims payment processing
Certified coder (ccs, ccs-p or cpc)
Rn, lpn or lvn preferred
Ability to interpret claim edit rules and references
Solid understanding of claims workflow and the ability to interpret professional and facility claim forms
Ability to apply industry coding guidelines to claim processes
Ability to perform audits of claims processes and apply root-cause
Ability to manipulate data in excel
Experience managing business relationships
Excellent verbal & written communication skills
Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claimsZelis delivers integrated network analytics, network solutions, payment integrity, electronic payments and claims communications for payers, healthcare providers and consumers in the medical, dental and workers` compensation markets nationwideZelis is backed by parthenon capital partners and bain capital.
“we are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.”
