Sr Medicaid Reimbursement Regulatory Analyst
Sr Medicaid Reimbursement Regulatory Analyst
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Job Description
At Zelis we Get Stuff Done. So lets get to it!
A Little About Us
Zelis is modernizing the healthcare financial experience for all by providing a connected platform that bridges the gaps and aligns interests across payers providers and healthcare consumers. This platform serves more than 750 payers including the top 5 national health plans BCBS insurers regional health plans TPAs and selfinsured employers and millions of healthcare providers and consumers. Zelis sees across the system to identify optimize and solve problems holistically with technology built by healthcare expertsdriving real measurable results for clients.
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 youve learned along the way. You are more than just your resume; you are a reflection of your achievements the knowledge youve gained and the personal interests that shape who you are.
Position Overview
The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory Pricer Product team to further the companys goals by researching analyzing documenting and communicating rules regulations and procedures pertaining to public and private Medicaid payment systems. This position requires an indepth knowledge of healthcare pricing/reimbursement processes and procedures including institutional as well as professional payment systems. This position is an internal subject matter expert supporting staff and clients and will need to respond to both internal and external issues in an accurate and timely fashion.What youll do:
Research and decipher regulatory sources such as legislative rules state registers waiver programs and bulletins regarding payment rules for State Medicaid programs as well as deciphering contractual language regarding commercial payment arrangements.
Draft concise documentation for payment proceduresincluding payment calculation logicand collaborate with the development team to refine into user stories with acceptance criteria including creating test cases/claims with expected pricing outcomes.
Perform analysis of various data sources including but not limited to published fee schedules and provider files using inhouse or offtheshelf software (such as Microsoft Excel)
Interact with regulators and clients to determine and document business requirements.
Lead pricer maintenance quality assurance activities audits troubleshooting and defect corrections.
Educate internal and client staff regarding payment systems and procedures.
Updates internal documentation and processes as needed.
Work with supporting staff to oversee one or more payment systems.
Identify issues upfront and communicate clearly to team members and leadership.
Manage competing priorities and deliver quality information and analysis while adhering to deadlines.
What youll bring to Zelis:
Bachelors degree or equivalent experience in healthcare administration business administration or a related field
Five years of experience in Medicaid billing reimbursement claim payment or cost reporting.
Experience with Medicare/Medicare Advantage or commercial billing and reimbursement a plus
Ability to manage/oversee pricer program.
Subject matter expertise in prospective payment systems and advanced reimbursement methodologies.
Strong analytical and critical thinking skillsthe ability to correctly decipher dense regulatory or procedural language such as federal or state administrative code.
Ability to prioritize multiple tasks and meet deadlines with minimal supervision including managing program deliverables and providing estimates for deliverables.
Ability to define issues collect data establish facts and draw valid conclusions.
Strong research and data analysis skills
Ability to troubleshoot production issues.
Proficient Microsoft Office skills (i.e. functions macros pivot tables data validation business requirement writing etc.)
Proficient writing SQL queries
A good understanding of public and private healthcare payment systems medical claims standard claim coding claim editing contracting preferredprovider organizations narrow networks and other healthcarerelated organizational constructs.
Ability to understand inhouse developed systems and identify risks with or gaps in those systems.
Strong communication skills collaboration and active listening to contribute to solving problem and building product solutions.
Location and Workplace Flexibility
We have offices in Atlanta GA Boston MA Morristown NJ Plano TX St. Louis MO St. Petersburg FL and Hyderabad India. We foster a hybrid and remote friendly culture and all our employees work locations are based on the needs of the position and determined by the Leadership team. Inoffice work and activities if applicable vary based on the work and team objectives in accordance with Company policies.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified 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 welcome applicants from all backgrounds and encourage you to apply even if you dont meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.
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 .
Disclaimer
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex gender identity national origin disability status protected veteran status or any other characteristic protected by law.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities duties and skills from time to time.
Required Experience:
Senior IC
Employment Type
Full-Time
