Concept Coding Analyst

At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience 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. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The Concept Coding Analyst will be responsible for researching, developing, and creating the requirements for new and enhanced edit concepts. The Concept Coding Analyst will develop high quality edits to drive growth of the Claims Editing platform. The Analyst will be responsible for performing research initiatives and analysis and requirements definition of new edits as well as any opportunities for expansion and refinement of existing edits. What You'll Do: * Research, analysis, and quality assurance of new and existing edit concepts focused on areas for growth of the Claims Editing library, * Engage with Business Intelligence team to perform edit data analysis and create specifications for data analysis * Document edit specifications for data analytics, development, and implementation * Provide coding and industry expertise to drive new opportunities of edit concepts as well as helping client teams with customer and provider inquiries * Ensure adherence to quality assurance and coding guidelines * Participate in building/creating edit requirements in Confluence * Request and review data analytics in support of edit * Present and obtain edit approval to stakeholders * Work with development to ensure edit is built as intended * Provide the scripts for communicating the intent, description, and example of the new edit * Monitor, research, and summarize trends, coding practices, and regulatory changes, ensuring compliance with HIPAA * Ensure compliance with HIPAA regulations and requirements * Maintain awareness of and ensure adherence to Zelis standards regarding privacy What You'll Bring to Zelis: * 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/guidelines and applicable industry standards (Health Insurance, Medicare, Medicaid,etc.) *... For full info follow application link. Zelis provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genet ics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.