Data Driven Edit (DDE) Analyst
The DDE Analyst role will partner closely with the team around projects around the build out of the claims edit platform for physician and facility claims including support for communication and documentation. Will work closely with Ops, Sales & IT departments in the development of edits as it relates to scalability, functionality, and initiatives imperative to growth.
- Primary focus on Data Driven Edit (DDE) development
- Research, build and test edits to be used in the Claims Editing library of edits.
- Use of strong coding and industry knowledge to build edits and editing content (data used by the edits).
- Ensure compliance with HIPAA regulations and requirements.
- Ensure adherence to quality assurance guidelines.
- Serve as a subject matter expert for edits and provide support where needed.
- Work closely with client teams to provide coding expertise for customer and provider inquiries
- Provide written response, documentation and rationale for inquiries as needed.
- Utilize the most up-to-date approved Zelis medical coding sources for edit development while also advising appropriate personnel of important changes, issues, and trends.
- Test and validate changes made to the edit(s).
- Monitor, research, and summarize trends, coding practices, and regulatory changes.
- Performs other related responsibilities and special projects as assigned.
- Maintains awareness of and ensure adherence to ZELIS standards regarding privacy.
- Partner with other areas to assess and communicate impact to the business for additions, changes, or updates as it relates to edit updates.
- 5+ years’ experience healthcare or related industry.
- Current certified coder (CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT), or RN, LPN with coding knowledge.
- Proficient in Microsoft Word and PowerPoint.
- Intermediate to Advanced Excel skills preferred.
- Creative problem-solving skills, leveraging insights and input from other parts of an organization while remaining curious
- Consistently demonstrate ability to act and react swiftly to continuous challenges and changes.
- Excellent analytical skills with data and analytics related solutions.
- Excellent communication skills.
- Strong organization and project / process management skills.
- Strong initiative, self-directed and self-motivation.
- Good negotiation, problem solving, planning and decision-making skills.
- Ability to manage projects simultaneously and achieve goals.
- Excellent follow through, attention to detail, and time management skills.
- Current, active CPC or equivalent credentialing required.
- Bachelor’s Degree Preferred in business, healthcare, or technology preferred.
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.
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
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