Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. The company develops technology-driven solutions that help price, pay, and explain healthcare claims.
This role supports bill review content management with a primary focus on concept development for DRG coding and clinical validation, along with itemized bill review (IBR). The position partners with Operations, Product, and Clinical leadership to create, maintain, and improve bill review content, dispute rationales, policies, and supporting documentation.
Key responsibilities include researching coding concepts and regulatory changes, reviewing provider disputes, analyzing content issues and defects, creating education for internal teams, and helping drive scalability, automation, and process improvements. The role also collaborates on product alerts, content updates, and compliance-related enhancements.
Qualifications
- Current active CIC or CCS credential, or equivalent
- RN or LPN with coding certification, certified coder, or RHIA/RHIT with 6-8 years of experience
- Experience with MS-DRG and APR-DRG coding and compliance
- Strong regulatory research, analysis, and presentation skills
- Knowledge of National Medicare and Medicaid regulations
- Knowledge of payer reimbursement policies
- Ability to analyze claim data and use reporting tools for trend identification
- Strong organization and project/process management skills
- Familiarity with JIRA and Confluence is recommended
Additional expectations
- Ability to manage multiple priorities and meet deadlines
- Strong written and verbal communication skills
- Comfort working independently with confidentiality and accountability
Benefits
- Competitive base salary
- Possible discretionary bonus, commissions, or other incentives depending on role
- 401(k) with employer match
- Flexible paid time off
- Holidays
- Parental leave
- Life and disability insurance
- Medical, dental, vision, and prescription drug coverage
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$105,000 - $133,000
Remote work allowed
Yes
Posted
1 month ago