Zelis Healthcare, LLC
Overview
Position Overview
The Client Inquiry Analyst is responsible for the resolution of inquiries for all assigned Zelis editing clients. The Client Inquiry Analyst will act as a subject matter expert (SME) as it pertains to correct coding/claim adjudication guidelines and the Zelis editing product. The Client Inquiry Analyst will provide written responses to all client inquiries adhering to all key performance components to achieve goals and results for the Zelis Claims Cost Solutions department. The Client Inquiry Analyst will support the day-to-day activities of the assigned team ensuring it aligns with the overall mission and adherence to best practice policies as defined by the organization. This role is responsible for ongoing support of our products and services for our clients. This role involves analyzing client data, identifying trends, and providing actionable insights to improve client satisfaction and retention. The Analyst will work closely with cross-functional teams to deliver exceptional client experiences and drive continuous improvement.
What you'll do
Perform as subject matter expert (SME) to provide coding and claim adjudication guidance for all assigned clients.
Demonstrate an expert level of understanding of the Zelis editing products with an ability to clearly articulate correct coding and claim adjudication guidelines.
Demonstrate the ability to provide written responses that provides clarity and guidance to all internal and external client inquiries.
Effectively utilize all tools and applications for the resolution and escalation of all internal/external edit/claim inquiries.
Manage day-to-day activities to ensure all inquiries received are responded to and resolved within appropriate timeframes per specified Service Level Agreements (SLAs).
Actively participate in all external/internal client meetings by providing an overview of identified inquiry or edit trends for assigned clients.
Proactively identify, resolve and escalate client issues while effectively partnering with assigned business partners to maintain strong internal and external relationships.
Effectively analyze data to ensure proactive identification, escalation and resolution of client issues and effectively prioritize to deliver on-time completion of all tasks assigned.
Ensure compliance with HIPAA regulations and requirements.
Build and maintain strong, long-lasting relationships with other teams through regular communication and proactive engagement.
Analyze client data to identify trends, patterns, and areas for improvement.
Develop and deliver insightful reports and presentations to clients, highlighting key findings and recommendations.
Monitor client performance metrics and provide actionable insights to drive client success.
Collaborate with cross-functional teams to identify and implement process improvements that enhance the client experience.
Gather and analyze client feedback to inform product development and service enhancements.
Stay up-to-date with industry trends and best practices to ensure our client success strategies remain competitive and effective.
What you'll bring to Zelis
Bachelor's degree in Business, Healthcare, Data Analytics, or a related field. Or equivalent experience.
3+ years of relevant education and work experience with healthcare payers.
Current certified coder (AAPC or AHIMA), Registered Health Information (RHIA/RHIT) certifications, or RN/LPN with coding knowledge required.
Extensive knowledge of correct coding, 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.
Excellent verbal & written communication skills
Strong analytical skills with the ability to interpret complex data and provide actionable insights.
Proficiency in data analysis tools and software (e.g., Excel, SQL, Tableau).
Strong problem-solving skills and the ability to think critically and strategically.
Ability to work independently and as part of a team in a fast-paced, dynamic environment.
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 employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.
Base Salary Range $65,000.00 - $87,000.00
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 TalentAcquisition@zelis.com.
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.
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The Client Inquiry Analyst is responsible for the resolution of inquiries for all assigned Zelis editing clients. The Client Inquiry Analyst will act as a subject matter expert (SME) as it pertains to correct coding/claim adjudication guidelines and the Zelis editing product. The Client Inquiry Analyst will provide written responses to all client inquiries adhering to all key performance components to achieve goals and results for the Zelis Claims Cost Solutions department. The Client Inquiry Analyst will support the day-to-day activities of the assigned team ensuring it aligns with the overall mission and adherence to best practice policies as defined by the organization. This role is responsible for ongoing support of our products and services for our clients. This role involves analyzing client data, identifying trends, and providing actionable insights to improve client satisfaction and retention. The Analyst will work closely with cross-functional teams to deliver exceptional client experiences and drive continuous improvement.
What you'll do
Perform as subject matter expert (SME) to provide coding and claim adjudication guidance for all assigned clients.
Demonstrate an expert level of understanding of the Zelis editing products with an ability to clearly articulate correct coding and claim adjudication guidelines.
Demonstrate the ability to provide written responses that provides clarity and guidance to all internal and external client inquiries.
Effectively utilize all tools and applications for the resolution and escalation of all internal/external edit/claim inquiries.
Manage day-to-day activities to ensure all inquiries received are responded to and resolved within appropriate timeframes per specified Service Level Agreements (SLAs).
Actively participate in all external/internal client meetings by providing an overview of identified inquiry or edit trends for assigned clients.
Proactively identify, resolve and escalate client issues while effectively partnering with assigned business partners to maintain strong internal and external relationships.
Effectively analyze data to ensure proactive identification, escalation and resolution of client issues and effectively prioritize to deliver on-time completion of all tasks assigned.
Ensure compliance with HIPAA regulations and requirements.
Build and maintain strong, long-lasting relationships with other teams through regular communication and proactive engagement.
Analyze client data to identify trends, patterns, and areas for improvement.
Develop and deliver insightful reports and presentations to clients, highlighting key findings and recommendations.
Monitor client performance metrics and provide actionable insights to drive client success.
Collaborate with cross-functional teams to identify and implement process improvements that enhance the client experience.
Gather and analyze client feedback to inform product development and service enhancements.
Stay up-to-date with industry trends and best practices to ensure our client success strategies remain competitive and effective.
What you'll bring to Zelis
Bachelor's degree in Business, Healthcare, Data Analytics, or a related field. Or equivalent experience.
3+ years of relevant education and work experience with healthcare payers.
Current certified coder (AAPC or AHIMA), Registered Health Information (RHIA/RHIT) certifications, or RN/LPN with coding knowledge required.
Extensive knowledge of correct coding, 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.
Excellent verbal & written communication skills
Strong analytical skills with the ability to interpret complex data and provide actionable insights.
Proficiency in data analysis tools and software (e.g., Excel, SQL, Tableau).
Strong problem-solving skills and the ability to think critically and strategically.
Ability to work independently and as part of a team in a fast-paced, dynamic environment.
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 employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.
Base Salary Range $65,000.00 - $87,000.00
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 TalentAcquisition@zelis.com.
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.
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