Job details
Job type full-time
Full job description
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.
Position overview:
Zelis is pursuing an aggressive organic and non-organic growth strategy focused on providing superior healthcare claim lifecycle solutions to payors, providers and individuals from pre-payment through paymentAs the company executes its growth strategy, zelis is seeking to identify an accomplished edi subject matter expert manager, reporting directly to the senior director of payment operations, and working closely with the edi team members, other managers and the implementation department.
Key responsibilities:
Review x12 835 files for issues including but not limited to: balancing, structure, syntactical, data type and content errors; then develop and execute strategies to solve themTroubleshooting activities include querying our database using sql management studio to review stored values and/or using a text editor to manually review data files sent to zelis by our payer clients
Support payer and provider client implementation activities by generating 835s files, reviewing their content and then presenting your findings to zelis clients
Keeping up to date with business and industry changes as it relates to hipaa edi x12 transactions sets (835), including attending conferences, webinars, etc.
Enroll providers in era products
Respond to inquiries regarding 835 issues, claims, payments, and/or clearinghouse activities
Work closely with other departments on communication issues related to customer and third-party vendor connectivity
Communicate with vendor contacts to identify file issues and then disseminate the resolutions to the provider or payer
Maintain compliance with all hipaa and zelis data security standards
Understand zelis payment products, protocols, systems and processes.
Support multiple client projects simultaneously
Must be proactive to ensure proper follow up and completion of projects.
Support other team members, providing a highly level of technical guidance, troubleshooting, training and mentoring where appropriate
Must maintain a professional demeanor in sensitive situations.
Make logical suggestions of likely causes of problems and indpendently suggest solutions
Track and communicate client feedback and track actionable items
Responsible for developing the team through motivation, counselling, skills development and product knowledge development
Provide qa coaching and feedback to associates
Contribute to operational improvement projects
Host regular 1-on-1’s and ad-hoc team meetings
Manage day-to-day activities, prioritize, and make risk/impact assessments within existing processes and procedures towards achieving kpis
Ensure training and development plans are maintained for all team members
Use company methodology, team input and own initiative to ensure attendance and performance targets are met
Manage the fair and consistent application of performance management and disciplinary measures as necessary
Responsible for supporting the department and manage associates through hr processes and annual reviews
Evaluate performance measures to highlight operational risks and areas for improvement by providing action items and smart goals for any negatively trending kpis
Professional experience:
5+ years of healthcare edi analysis including experience working with 835s and electronic payment operations
Minimum 1 year experience using c#, t-sql, linq or ssis in any combination
Have worked on assignments that are complex in nature in which judgment, critical thinking and initiative are required to accomplish the objectives of the assignment
Have successfully completed work tasks with minimal oversight
Have excellent organization skill and attention to detail
Have the ability to work under pressure and meet deadlines.
Have excellent communication and presentation skills
Have managed multiple associates in a department atmosphere
Education:
4-year college degree or equivalent technology/ 835 experience in addition to professional qualification above
Work environment:
Walking, standing and sitting.
Long periods of computer usage.
Handling – seizing, holding, grasping and fingering of objects, tools and controls.
Reaching
Vision – close vision
Office setting
Moderate noise level.
May be required to work on off hours and weekends.
`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.”
