Concept Coding Analyst

Zelis Healthcare, LLC; Cottonwood Heights (UT); Hybrid; USD 71,000 - 90,000; Full time

Benefits offered by this job

Hybrid work model

401k with employer match

Job summary

Zelis Healthcare, LLC is seeking a Concept Coding Analyst to research, define, and implement new edit concepts for our Claims Editing platform. You will collaborate with data, analytics, and development teams to deliver high-quality edits and drive growth.

You will analyze data, document specifications, and communicate requirements clearly to stakeholders while ensuring adherence to HIPAA and Zelis privacy standards across projects.

Qualifications

• 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.
• Code/Claims Editing experience preferred.
• Understanding of hospital coding and billing rules.
• Excellent written and verbal communication skills.
• Highly organized with attention to detail.
• Strong critical thinking and analytical skills.

Responsibilities

• Research, analysis, and quality assurance of new and existing edit concepts focused on 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.

Skills

Coding certification

Medical coding knowledge

Reimbursement knowledge

Payer policies & regs

Code/Claims editing

Hospital coding rules

Communication skills

Attention to detail

Analytical thinking

Job description

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.

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.)
• Code/Claims Editing experience preferred
• Understanding of hospital coding and billing rules
• Excellent written and verbal communication skills
• Highly organized with attention to detail
• Strong critical thinking and analytical skills

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

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In‑office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in‑office presence is guided by team and business needs rather than a fixed weekly schedule.

Base Salary Range

$71,000.00 - $90,250.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

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 don't 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 [e-mail].

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.