Concept Coding Analyst — Healthcare Claims Edits

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

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.