Zelis is a healthcare financial technology company focused on modernizing the healthcare payment experience across payers, providers, and consumers.
The Concept Coding Analyst is responsible for researching, developing, and creating requirements for new and enhanced edit concepts. This role supports the growth of the Claims Editing platform by performing analysis, defining requirements, documenting specifications, and partnering with internal teams to build and refine edits.
Key responsibilities include:
- Researching and analyzing new and existing edit concepts
- Documenting edit specifications for data analytics, development, and implementation
- Partnering with Business Intelligence and development teams
- Supporting client and provider inquiries with coding expertise
- Ensuring quality assurance and coding guideline adherence
- Monitoring coding trends, regulatory changes, and HIPAA compliance
- Presenting edits for approval and providing communication scripts for new edits
Requirements & Qualifications
Qualifications
- Coding certification required
- Clinical skills to evaluate appropriate medical record coding
- Extensive knowledge of reimbursement methodologies and acceptable billing practices
- Knowledge of payer reimbursement policies, state and federal regulations, and industry standards such as Health Insurance, Medicare, and Medicaid
- Experience with code/claims editing preferred
- Understanding of hospital coding and billing rules
- Strong written and verbal communication skills
- Highly organized with strong attention to detail
- Strong critical thinking and analytical skills
Benefits & Perks
Benefits
- Competitive base salary
- Discretionary bonus plans, commissions, or other incentives may be available depending on the role
- 401(k) plan with employer match
- Flexible paid time off
- Holidays
- Parental leave
- Life and disability insurance
- Medical, dental, vision, and prescription drug coverage
Location
Utah, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$71,000 - $90,250
Remote work allowed
No
Posted
1 month ago
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