Analyst I, Operations Support

As a Certified Claim Editing Resolution Analyst II at Zelis India, you will play a crucial role in reviewing and researching medical records for complex, multi-specialty provider claims. Your primary responsibility will be to identify and determine appropriately coded billed services in comparison to the Zelis Claim Edits Product. By processing, validating, routing, and responding to mid-level complex incoming Client and Provider corrected claims, disputes, and inquiries, you will contribute to maintaining the integrity of the editing product. Your role will involve researching medical records to ensure accurately coded billed services, resolving complex inquiries, and identifying any necessary updates on corrected claims, disputes, and edit validation submissions. Additionally, you will work towards identifying and retaining additional Client savings in a high-volume claim environment, driving monthly and quarterly revenue gains for Zelis. Monitoring turnaround time to ensure timely claim processing in compliance with Clients" Service Level Agreements will be essential to prevent negative financial impacts. As a resource, you will collaborate with internal colleagues to address edit discrepancies based on coding guidelines and Zelis processes, making recommendations for modifications to the Operations and Product teams. Your proficiency in utilizing industry standard tools and coding guidelines, including AMA, CMS, and Zelis Internal Manuals, will be crucial in ensuring accurate claim adjudication. To excel in this role, you must possess 3+ years of relevant experience or an equivalent combination of education and work within the healthcare industry. A certification as a Certified Coder (CCS, CCS-P, or CPC) or RN, LPN with a coding certification is required. Your knowledge of healthcare reimbursement policies, state and federal regulations, correct coding, and industry standard claim adjudication guidelines will be vital in performing your duties effectively. Excellent verbal and written communication skills, along with project management experience, are essential for successful collaboration with internal stakeholders and providing accurate content for Client and Provider inquiries. Proficiency in Microsoft Office suite (Word, Excel, PowerPoint, etc.) is expected, and holding a current active CPC or CCS or equivalent credentials is required for this position, with an Associate degree being preferred. Join Zelis India to be part of a dynamic environment that fosters professional growth, collaboration, and innovation in enhancing the healthcare financial experience.,