Client Policy Specialist Team Lead

Position Overview

The Client Policy Specialist Team Lead will act as the team lead and the subject matter expert (SME) as it pertains to Zelis editing product in support of the growth and expansion of strategic clients. The Client Policy Specialist Team Lead will lead the overview discussion of new/existing opportunities for the Zelis editing product during client meetings in partnership with the Client Management team. This includes but is not limited to review of client data to identify pre/postproduction edit volume and savings edit trends outliers while providing rationale and potential customization options to ensure Zelis edit logic is aligned with internal policies of assigned clients and their specific Lines of Business. The Client Policy Specialist Team Lead will ensure daytoday activities of assigned team aligns with the overall mission and adherence to best practice policies as defined by the organization. The Senior Client Policy Specialist will support the ongoing growth of the Client Policy Specialist Team in addition to support of strategic development as it pertains to client relationships and Client Policy Integration growth.

What youll do

• Demonstrate an expert level understanding of Zelis editing products with an ability to clearly articulate correct coding and claim adjudication guidelines interpretation of client policies and present Zelis edits/editing suites to assigned clients.

• Primary contact for Client Manager to support the retention and expansion of Zelis Editing Products for assigned clients.

• Ability to work daytoday with autonomy. Individual contributor as it pertains to assigned clients but works well with CPS team and provides guidance and asks questions as needed.

• Proactively partner with Zelis assigned clients to assist in questions concerns and provide explanations regarding editing logic CMS rules and regulations and assist in client operational efficiencies.

• Ability to recommend editing adjustments and modifications as needed to product and to the client.

• Monitors the recording of edit presentations potential savings and client edit decisions for recommended edits.

• Includes and identifies individual stakeholders for client meetings needs and solutions.

• Schedule internal stakeholder meetings for new edit offerings for assigned clients.

• Builds relationships internally with collaborative partners and follows processes well. Shares information across team without prompts and identifies issues and offers potential solutions.

• Proactively partner with Client Policy Integration Director for input regarding PreStakeholder meetings to validate preproduction data and client selection based on edit volume/potential savings opportunity.

• Demonstrate expertise in ability to document rootcause analysis of identified client editing issues for escalation to the appropriate Zelis internal team for resolution and communication to the client.

• Proactively monitor research and summarize changes to client payment policy during ongoing scheduled client meetings while partnering with Client Policy Team to ensure awareness of updates and revisions to Zelis Edits.

• Proactively monitor research and present edit customizations to clients to ensure that all customizations are uptodate and valid.

• Assists in ongoing process improvement and automation. Leads and teaches new onboarding Client Policy Specialist team members.

• Strategic thinker who identifies problems and offers ideas for potential solutions automation and ongoing growth support.

• Proactively escalate identified Zelis Editing Product issues utilizing all tools and resources to document and resolve issue.

• Effectively collaborate with the Zelis Editing Product team as it pertains to editing solutions new edit releases and product issues.

• Proactively partner with Product and Product Analytics team to obtain impact analysis with claim level details for production edits for all assigned clients to support upsell of existing/new production edit opportunities.

• Partner with Client Integration Specialist and Implementation teams to support the implementation of the Zelis Edit Products for new/existing clients which includes but is not limited to edit presentation interpreting client policies provide guidance for requested client customizations and support testing and client golive.

• Effectively partner with Edit Configuration and Claims Edit Validation Team to confirm client selected edit package set up with various lines of business (when applicable) interpret intent of client requested customizations confirm configuration of requested customizations and support postproduction validation of selected client approved edit and newly deployed edits.

• Reviews and provides recommendations for SOPs updated process guidance guidelines for review enhancements and automation.

• Monitors documentation of edit presentations potential savings and client edit decisions documented by the CPS and process improve to include automation of the process.

• Collaborate with the Claims Editing Product Client Integration and the Edit Configuration teams to maintain edit presentations tools as it relates to new and existing client presentations.

• Ensure compliance with HIPAA regulations and requirements.

What youll bring to Zelis

• 4 years of relevant experience or equivalent combination of education and work experience with healthcare payers third party administrators and health plans.

• Current certified coder (AAPC or AHIMA) or Registered Health Information (RHIA/RHIT) certifications required.

• Extensive knowledge of correct coding and industry standard claim adjudication guidelines and policies.

• Extensive knowledge and ability to translate coding and adjudication guidelines policies and references into edit policies and rules.

• 4 years minimum client facing and/or provider facing experience which includes but is not limited to conducting product overview and sales workshops.

• Extensive experience in managing internal/external relationships with strong Project Management skills.

• Excellent verbal & written communication skills

• Proficient in Microsoft Office suite (Word Excel Power Point etc.

• Proficient in JIRA