Contract Analyst II

Plano, TX - USA

Monthly Salary: Not Disclosed

Posted on: 23 hours ago

Vacancies: 1 Vacancy

Job Summary

At Zelis we Get Stuff Done. So lets 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.

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

Job Summary:
This position requires an incumbent to analyze healthcare reimbursement contracts and load contract terms between payers and providers in an accurate and timely manner using proprietary software. This position reports to the Manager of Contract Configuration and will collaborate with the programming and development teams in the creation and vetting of calculation methods database loads or changes. This position is an internal resource to staff and clients and as such is expected to respond to client issues and cases in a timely manner.

Duties and Responsibilities:

Set up basic contract loads: simple single case agreements (SCAs) basic % of billed charges (BCs) basic % of Medicare general carve-out codes and basic fee schedule set up.
Interpret complex contract terms analyze reimbursement methodologies and rate structures (e.g. DRG APC CPT/HCPCS ICD-10).
Load maintain and audit client contracts within the adjudication system.
Validate and test contract configurations for claims pricing accuracy.
Maintain fee schedule in contract databases and apply annual escalators for client auto renewals.
Link contracts to payer products update and maintain provider groups within client databases to ensure seamless claims routing.
Handles confidential material on a regular basis and is responsible for protecting the confidentiality of such information within the established guidelines of Company and law. (HIPAA Compliance)

Skills and Abilities:

Bachelors Degree or equivalent work experience in Healthcare Revenue Cycle Management/Contracting field

Microsoft product proficiency. Must be an intermediate to expert user of Excel

Posses strong analytical and math skills

Self Motivated and Detail Oriented
Effective written and verbal skills communicate effectively & expresses ideas clearly and succinctly.
Develops Self: Seeks opportunities for continuous learning. Modifies behavior in response to feedback. Knows personal strengths and weaknesses and demonstrates ownership for personal development.
Drives for Results: Delivers high quality work and attains results. Demonstrates personal drive and pushes self and others for results and quality work. Responds appropriately to urgent situations.
Plans and Organizes Effectively: Prioritizes the importance of tasks and goals. Manages time efficiently to accomplish priorities and overcome obstacles.
Displays Adaptability: Performs well in high pressure or stressful situations. Works effectively when direction is unclear or rapidly changing. Demonstrates persistence in the face of obstacles.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

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 -office 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

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:

At Zelis we Get Stuff Done. So lets get to it!A Little About UsZelis 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 p...