Perform end to end testing to ensure appropriate functionality, product integrity, accuracy, and quality of all changes and enhancements of the edit platform, Data Driven Edits PriZem (in-house system), Visium through the Payment Integrity (Claims Editing) process.
Analyze clinical and technical requirements and define the scope of UAT testing. Setup, develop and maintain detailed test scenarios, test suites, data, checklist and/or other documents as specified, ensuring test scenarios align to requirements, adhering to claim adjudication guidelines. While using best practices for software testing methodology and techniques.
Analyze and troubleshoot erroneous results, determine root cause, and suggest solutions.
Produce documents that are detailed, accurate, and in a consistent format, demonstrating strong analytical and documentation skills.
Continuous improvement and refinement of tests-based pre-production validation, post-production results and feedback from other groups (Configuration Department, Content Department and Operations teams) as needed.
Support multiple projects, initiatives, tasks, and maintenance releases while adhering to deadlines.
Maintain awareness of and ensure adherence to Zelis standards regarding privacy.
What You Will Bring
Highly organized and results driven.
Excellent problem solving and analytical skills.
Ability to prioritize and manage multiple concurrent projects.
Ability to work through others without direct supervisory responsibility within departments and across the organization.
Understanding of medical coding and medical claims.
Understanding of the life of a claim, including adjusted/corrected claims.
Excellent attention to detail to assess issues and resolve in a timely manner.
Basic database skills using MS SQL.
Ability to identify key factors and decisions that will make a project successful.
Ability to see the big picture and learn new processes, technologies and envision how they could benefit Zelis.
Must have excellent communication and presentation skills to effectively interface with team members.
Education
2-3 years of relevant experience or equivalent combination of education & work within healthcare payer or provider.
Knowledge of healthcare reimbursement methodologies and acceptable billing practices.
Knowledge of payer reimbursement policies, state and federal regulations and applicable industry standards.
Knowledge of claims adjudication process and interpret claim editing rules.
Certified coder (CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT), or RN, LPN with coding knowledge a plus.
Understanding of SQL Server 2000/2005/2008 is a plus.
Project management experience a plus.
Excellent written, oral and presentation skills and ability to communicate complex concepts.
Proficient in Microsoft Office, Word, Excel.
As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We're Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process. Commitment to Diversity, Equity, Inclusion, and Belonging At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All 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 encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities. 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 [HIDDEN TEXT] SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you're contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.
