Sr Medicaid Reimbursement Regulatory Analyst
Company: Zelis Healthcare, LLC
Location: Plano
Posted on: April 28, 2024
Job Description:
Position OverviewAt Zelis, the Sr Medicaid Reimbursement
Regulatory Analyst will collaborate with the Zelis Regulatory
Pricer Product team to further the company's goals by researching,
analyzing, documenting, and communicating rules, regulations, and
procedures pertaining to public and private Medicaid payment
systems. The Sr Medicaid Reimbursement Regulatory Analyst position
requires an in-depth knowledge of healthcare pricing/reimbursement
processes and procedures including institutional, as well as
professional payment systems. This position is an internal subject
matter expert supporting staff and clients and will need to respond
to both internal and external issues in an accurate and timely
fashion.Key Responsibilities
- Research and decipher regulatory sources such as legislative
rules, federal registers, and bulletins regarding payment rules for
Medicare as well as deciphering contractual language regarding
commercial payment arrangements
- Draft concise documentation for payment procedures-including
payment calculation logic-and collaborate with the development team
to refine into user stories with acceptance criteria, including
creating test cases/claims with expected pricing outcomes
- Perform analysis of various data sources, including but not
limited to, published fee schedules and provider files, using
in-house or off-the-shelf software (such as Microsoft Excel)
- Interact with regulators and clients to determine and document
business requirements
- Lead pricer maintenance, quality assurance activities, audits,
troubleshooting, and defect corrections
- Educate internal and client staff regarding payment systems and
procedures
- Updates internal documentation and processes
- Work with supporting staff to oversee one or more payment
systems
- Manage competing priorities and deliver quality information and
analysis while adhering to deadlinesPreferred Qualifications
- 5+ years of experience in Medicaid billing, reimbursement,
claim payment or cost reporting
- Ability to manage/oversee pricer program
- Subject matter expertise in prospective payment systems and
advanced reimbursement methodologies
- Strong research and data analysis skills
- Proficient writing SQL queries
- A good understanding of public and private healthcare payment
systems, medical claims, standard claim coding, claim editing,
contracting, preferred-provider organizations, narrow networks, and
other healthcare-related organizational constructs
- Medicaid or commercial billing and reimbursement
experience
- Strong analytical and critical thinking skills - ability to
correctly decipher dense regulatory or procedural language such as
federal or state administrative code#LI-RZ1As 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 BelongingAt 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 SupportWe 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
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.
Keywords: Zelis Healthcare, LLC, Frisco , Sr Medicaid Reimbursement Regulatory Analyst, Professions , Plano, Texas
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