Zelis is a healthcare information technology company and market-leading provider of end-to-end healthcare claims cost management and payment solutions.Inc.5000 award winner: One of the fastest growing privately held companies in the US!Ranked #1 by NJ Biz as the Fastest Growing Company in NJ!COMPANY BACKGROUND/CULTURE
Zelis is a mid-cap healthcare technology growth company and market-leading provider of integrated healthcare cost management and payments solutions including network analytics, network access, network cost management, payment integrity and electronic payments to payers, healthcare providers and consumers in the medical, dental and workers' compensation markets nationwide. Zelis is backed by Parthenon Capital Partners. www.zelis.comOur Zelis Purpose
We founded Zelis to help control the rising cost of healthcare and make healthcare more affordable for all of us.Position Overview
The Manager, Coding Research & Testing, is a key role responsible for partnering with the Sr. Director Configuration and Coding Compliance to manage projects around the build out of the claims edit platform for physician and facility claims. Will work closely, as needed, with Ops, Sales & IT departments in the development and maintenance of the current product as it relates to scalability, functionality and initiatives imperative to growth.KEY RESPONSIBILITIES
- Will support and lead, as assigned, projects surrounding the build out of the Zelis Claims Editing Engine including but not limited to the edit rules engine, user interface, expansion of the client facing web portal, etc.
- Partner with Senior Director for research and development process of building edits, planning for development and phases for production
- Assist with product scope and ensure capabilities align with all lines of business for payors, including Group Health, Medicare & Medicaid
- Work closely with Zelis teams in the creation of business models applicable to Claims Editing for Medicare & Medicaid payors
- Conduct research and analysis for medical policy items for configuration of Zelis edits; work with Senior Director to determine how they can be configured to comply with client specific clinical and payment policy.
- Work with Healthcare Economics team, as assigned, to understand data and report impact for determination of ROI and action steps.
- Review and analyze complex inpatient, outpatient, and practitioner billing for medical appropriateness of treatment; analyze charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type including any additional information perceived as potentially helpful for new edit creation, updating or expanding existing edits
- Monitor, research, and track/summarize changes as client payment and medical policy changes.
- Partner with IT and operations to streamline processes, as well as create or enhance reports and tools impacting the creation of new edits or revision/updating of existing edits, including the identification of requirements/functionality and user acceptance testing.
- Develop a research plan, priority and timeline for identified potential edit expansion opportunities
- Ensure compliance with HIPAA regulations and requirements.
- Maintain awareness of and ensure adherence to Zelis standards regarding privacy.
- 7+ years of relevant experience or equivalent combination of education & work within healthcare payers
- Extensive knowledge of reimbursement methodologies and acceptable billing practices
- Knowledge of payer reimbursement policies, state and federal regulations and applicable industry standards
- Current certified coder (CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT) , or RN, LPN with coding knowledge required
- Project management
- Experience managing internal and external relationships
- Excellent verbal & written communication skills
- Proficient in Microsoft Office, Word, Excel
Bachelor s Degree PreferredDIRECT REPORTS:
UAT AnalystsWork 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.
- A standard business environment exists with moderate noise levels.
- Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
- Ability to sit for extended periods of time.
An attractive compensation package comprised of base salary, plus incentives, as well as full benefits has been created to attract outstanding candidates.OUR BIG 8 ZELIS VALUES
Thank you for your interest in the Zelis team!
- We take personal accountability
- We look for a better way
- We serve each other and are always there to help
- We act level-less
- We use humor
- We develop serious expertise
- We act with integrity
- We celebrate