Healthcare Business Analyst - Expert Claims Review

Position Overview

At Zelis, t he Business Analyst - Expert Claims Review (ECR) is ultimately responsible for enabling high quality user stories under our ECR product umbrella.

This includes Itemized Bill Review, Clinical Chart Review, Dialysis Savings Solution and DRG Validation solutions.

In this role, you will work as part of the Product team to facilitate clear and open communication between Business Owners, Scrum / Development, Quality Assurance, UAT and Product Owners.

This role provides a major contribution to source technological improvements, process improvements, enhancements to workflow, ultimately enhancing Zelis' overall capacity to meet the information technology needs of an ever-changing payment integrity market.

Key Responsibilities

Gather requirements / acceptance criteria for Expert Claims Review initiatives centered around handling of medical pre-payment and post-payment claims for accurate claim payment review through our suite of solutions

Provide documentation for system / process updates and existing system functionality for reference by operations and alternate teams

Support training to operations on newly released items

Recommend process, workflow and efficiency improvements

Communicate product development improvements and new product solutions being taken to market

Draft and send release notes and organize user requirements; track and manage accordingly

Qualifications

Basic or advanced understanding of payment integrity, claim processing and / or revenue cycle for healthcare claims

Understanding of medical coding and medical claims

Project Management experience; ability to drive output from others without direct supervisory responsibility

Moderate to advanced experience with Microsoft Office Suite, JIRA + Confluence

LI-RZ1

LI-Hybrid

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

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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.

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