zelis
Website:
zelis.com
Job details:
About Us
Zelis is modernizing the healthcare financial experience in the United States (U.S.) across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.
At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.
Why We Do What We Do
In the U.S., consumers, payers, and providers face significant challenges throughout the healthcare financial journey. Zelis helps streamline the process by offering solutions that improve transparency, efficiency, and communication among all parties involved. By addressing the obstacles that patients face in accessing care, navigating the intricacies of insurance claims, and the logistical challenges healthcare providers encounter with processing payments, Zelis aims to create a more seamless and effective healthcare financial system.
Zelis India plays a crucial role in this mission by supporting various initiatives that enhance the healthcare financial experience. The local team contributes to the development and implementation of innovative solutions, ensuring that technology and processes are optimized for efficiency and effectiveness. Beyond operational expertise, Zelis India cultivates a collaborative work culture, leadership development, and global exposure, creating a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we foster a holistic workplace experience. Additionally, the team plays a vital role in maintaining high standards of service delivery and contributes to Zelis’ award-winning culture.
Position Overview
The Data Driven Edit (DDE) Analyst role is responsible for development and delivery of initiatives focused on editing. The Data Driven Edits Team builds edit suites using industry and proprietary sources (AMA, CPT, AAPC, CMS, etc.).
The DDE Analyst role will partner closely with the team around projects around the build out of the claims edit platform for physician and facility claims including support for communication and documentation. Will work closely with Ops, Sales & IT departments in the development of edits as it relates to scalability, functionality, and initiatives imperative to growth.
Key Responsibilities
- Primary focus on Data Driven Edit (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 rationale 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 certified 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
- Current, active CPC or equivalent credentialing required.
- Bachelor’s Degree Preferred in business, healthcare, or technology preferred.
Work Environment
- Travel requirements to (primarily) domestic destinations should not exceed 10%.
- A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.
- Ability to sit for extended periods of time.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.
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 qualified 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.
Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability and require reasonable accommodation with any part of the application and/or interview process, please email talentacquisition@zelis.com.
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